UC-NRLF 


MEDICAL  HANDBOOK 

FO&  TEE  USE  OF 

LIGHTHOUSE  VESSELS  AND  STATIONS 

1912 


LIBRARY 

OF  THE 

UNIVERSITY  OF  CALIFORNIA. 


GIFT    OF 


Class 


DEPARTMENT  OF  COMMERCE  AND  LABOR 
BUREAU  OF  LIGHTHOUSES 


MEDICAL  HANDBOOK 


FOR  THE  USE  OF 


LIGHTHOUSE  VESSELS  AND  STATIONS 


Revised  by 

W.  J.  PETTUS,  M.  D. 

Assistant  Surgeon  General 
United  States  Public  Health  and  Marine-Hospital  Service 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1912 


CONTENTS. 


Page. 

Medicines  and  articles  to  be  supplied  for  medicine  chests 6 

Sanitation 7 

Poisons  and  antidotes 9 

Use  of  clinical  thermometer 9 

Malarial  fever » 10 

Measles 12 

Mumps 14 

Smallpox 15 

Dysentery 18 

Sunstroke 19 

Diarrhea 20 

Cholera  morbus 21 

Colic 22 

Scurvy 23 

Sore  throat 24 

Coughs  and  colds 25 

Erysipelas '. .  26 

Poison  ivy 27 

Rheumatism 27 

Fainting 30 

Delirium  tremens 30 

Appendicitis 31 

Syphilis 31 

Soft  chancre  (chancroids) 32 

Gonorrhea 34 

Stricture 35 

Boils 37 

Piles " 37 

Injuries— Hemorrhage  (bleeding) 37 

Wounds 38 

Burns  or  scalds 40 

Effects  of  cold— Frostbite 41 

Scalp  wounds 42 

Injuries  to  the  chest 42 

Injuries  to  the  back 43 

Fractures 43 

Dislocations 56 

Sprains 63 

Nosebleed 64 

Drowning 65 

3 


236586 


MEDICAL  HANDBOOK  FOR  THE  USE  OF  LIGHTHOUSE 
VESSELS  AND  STATIONS. 


DEPARTMENT  OP  COMMERCE  AND  LABOR, 

BUREAU  or  LIGHTHOUSES, 
Washington,  D.  C.,  February  1, 1912. 

This  Handbook  has  been  prepared  for  the  benefit  of  officers  and 
employees  of  the  Lighthouse  Service,  whose  duty  on  vessels  and  at 
remote  stations  may  render  it  difficult  at  times  for  them  to  obtain 
necessary  medical  assistance  or  advice.  In  all  cases  of  serious  sick- 
ness or  injury,  however,  medical  attendance  should  be  obtained  as  soon 
as  practicable.  Written  directions  must  very  imperfectly  supply  the 
place  of  the  physician  and  surgeon.  With  a  medicine  chest  and 
handbook  it  is  not  possible  to  provide  for  and  explain  the  treatment 
of  more  than  a  few  of  the  commoner  diseases  by  persons  who  have 
not  had  a  medical  education. 

Medicine  chests,  equipped  with  the  list  of  articles  given  herein, 
will  be  supplied  to  the  vessels  and  remote  stations,  as  approved. 
Such  chests  must  be  kept  accessible,  frequently  inspected,  and  fully 
equipped.  The  dates  when  obtained  must  appear  on  all  medicines 
and  packages,  and  they  must  be  renewed  when  no  longer  serviceable, 
according  to  the  length  of  time  stated  in  the  list  of  medicines  and 
articles. 

Sick  or  disabled  persons  employed  on  vessels  of  the  Lighthouse 
Service  will  be  admitted  to  the  benefits  of  any  United  States  marine 
hospital  without  charge  at  any  time  upon  application  of  their  re- 
spective commanding  officers. 

This  Handbook  is  a  revision  for  the  use  of  the  Lighthouse  Service 
of  the  Handbook  for  the  Ship's  Medicine  Chest,  prepared  by  George 
W.  Stoner,  surgeon,  United  States  Public  Health  and  Marine- 
Hospital  Service,  by  direction  of  the  Surgeon  General  of  that  Service. 

G.  R.  PUTNAM, 
Commissioner  of  Lighthouses. 

5 


6  MEDICAL  HANDBOOK. 

MEDICINES  AND  ARTICLES  TO  BE  SUPPLIED  FOR  MEDICINE  CHESTS. 


For  lighthouse 
vessels. 

For  light  stations. 

Item. 

1  pound  

1  pound  

Absorbent  cotton. 

8  ounces  

4  ounces  

Aromatic  spirits  of  ammonia  (1  year) 

1  yard  

1  yard  

Belladonna  plaster  (1  year) 

4  ounces  

4  ounces  

Bicarbonate  of  eoda 

100 

100.. 

(Poison)    Bichloride    of   mercury     antiseptic 

100  

100  

tablets  of  7.3  grains  each.     One  tablet  to  pint 
of  water  makes  solution  1  part  bichloride  to 
1,000  of  water. 
Bismuth  subnitrate,  5-grain  tablets. 

1  pound  

•i  pound  .  . 

Boric  acid,  powdered. 

200  

100  

Brown  mixture,  lozenges 

200  

100  

(Poison)  Calomel,  T\j-grain  tablets. 

100  

100  

(Poison)  Camphor  and  opium  pills. 

16  ounces  

8  ounces  

(Poison)  Carbolic  acid. 

16  ounces  

8  ounces  

Castor  oil 

100  

100     

Copaiba  5-minim  capsules. 

1  

1  

Court-plaster,  envelope                      . 

1  ounce  

£  ounce  

Creosote. 

2  pounds  

1  pound  

Epsom  salts 

12  rolls.  . 

6  rolls 

Gauze  2-inch  bandage. 

10  yards 

5  yards 

Gauze  plain,  aseptic 

16  ounces  

8  ounces  

Glycerin. 

8  ounces  

4  ounces  

(Poison)  Laudanum  (1  year). 

2  pounds 

1  pound 

Mustard 

12  

12  

Mustard  plasters,  in  boxes. 

16  ounces  

16  ounces  

Olive  oil. 

8  ounces  

4  ounces  

(Poison)  Paregoric  (1  year). 

32  ounces  

16  ounces 

Petrolatum 

100  

100  

Potassium  bromide,  5-grain  tablets. 

100  

100  

Potassium  chlorate,  5-grain  tablets. 

100  

100  

Potassium  iodide,  5-grain  tablets. 

100  

100  

Quinine,  5-grain  tablets. 

2  

1  

Rubber  adhesive  plaster,  10-yard  wheel,  1  inch 

1.. 

1  

wide  (1  year). 
Rubber  catheter  No.  10,  English  (1  year). 

200        

100      

Salicylate  of  soda,  5-grain  tablets. 

32  ounces.  . 

16  ounces 

Soap  liniment. 

1  

1  

Spool  of  silk  ligature,  medium  size. 

100  

100  

Strychnia  sulphate,  ^f-graiD.  tablets. 

200  

200  

(Poison)     Sun    cholera    mixture,     15-minim 

2  

2  

tablets. 
Surgical  needles,  in  glass-stoppered  bottles. 

1  

1  

Thermometer,  clinical,  self-registering,  Fahren- 

8 ounces  

4  ounces  

heit. 
(Poison)  Tincture  of  iodine. 

8  ounces  

4  ounces  

Tincture  of  myrrh. 

These  medicines  will  remain  serviceable  until  used  if  kept  in  glass- 
stoppered  bottles,  with  the  exception  of  those  marked  "  1  year," 
which  should  be  renewed  after  that  interval. 

For  bulky  articles  not  over  a  pint  of  each  need  be  kept  in  the 
medicine  chest. 

All  poisonous  medicines  must  be  plainly  so  marked  on  the  bottles 
or  packages. 


SANITATION.  7 

SANITATION. 

On  vessels. — The  master  of  a  vessel  should  observe  the  following 
measures  on  board  his  vessel,  and  the  same  rules  should  be  applied  at 
light  stations,  so  far  as  useful. 

The  water-closets,  forecastle,  bilges,  and  similar  portions  of  the 
vessel  liable  to  harbor  infection  should  be  frequently  cleansed. 

Free  ventilation  and  rigorous  cleanliness  should  be  maintained  in 
all  portions  of  the  ship  during  the  voyage  and  measures  taken  to 
destroy  rats,  mice,  fleas,  flies,  roaches,  mosquitoes,  and  other  vermin. 

A  patient  sick  of  a  communicable  disease  should  be  isolated  and 
one  member  of  the  crew  detailed  for  his  care  and  comfort,  who,  if 
practicable,  should  be  immune  to  the  disease. 

Communication  between  the  patient  or  his  nurse  and  other  persons 
on  board  should  be  reduced  to  a  minimum. 

Used  clothing,  body  linen,  and  bedding  of  the  patient  and  nurse 
should  at  once  be  immersed  in  boiling  water  or  in  a  disinfecting  solu- 
tion of  1  to  1,000  bichloride  of  mercury,  and  should  be  kept  so  im- 
mersed for  20  minutes. 

The  compartment  from  which  the  patient  was  removed  should  be 
disinfected  and  thoroughly  cleansed. 

Any  person  suffering  from  malarial  fever  should  be  kept  under 
mosquito  bars  and  the  apartment  in  which  he  is  confined  closely 
screened  with  mosquito  netting.  All  mosquitoes  on  board  should  be 
destroyed  by  burning  Pyrethrum  powder  (Persian  insect  powder) 
or  by  fumigation  with  sulphur,  burning  4  pounds  sulphur  to  1,000 
cubic  feet  air  space,  the  room  or  compartment  to  be  closed  for  4  hours. 
Mosquito  larvae  (wigglers  or  wiggle  tails)  should  be  destroyed  in 
water  barrels,  casks,  and  other  collections  of  water  about  the  vessel 
by  the  use  of  petroleum  (kerosene).  Where  this  is  not  practicable, 
use  mosquito  netting  to  prevent  the  exit  of  mosquitoes  from  such 
breeding  places. 

Formulas  for  disinfecting  solutions  recommended  for  use. 

Bichloride  of  mercury  (1 : 1,000)  : 

Bichloride  of  mercury . 1 

Sea  water ; 1, 000 

Carbolic  acid  (2.5  per  cent)  : 

Carbolic  acid,   pure : 25 

Fresh  water 1,  000 

Flies  as  carriers  of  disease. — It  is  a  well-known  fact  that  flies  carry 
the  germs  of  such  well-known  diseases  as  tuberculosis,  typhoid  fever, 
and  probably  smallpox;  hence  the  importance  of  preventing  their 
breeding  near  a  dwelling  or  securing  access  to  a  house.  They  breed 
in  such  things  as  stable  manure,  garbage,  etc.,  in  from  eight  to  ten 
days  after  the  eggs  are  deposited.  The  fly  deposits  its  eggs,  which 


8  MEDICAL  HANDBOOK. 

in  a  few  days  hatch  into  a  white  worm,  popularly  called  the  mag- 
got, then  turning  into  the  fly.  If  there  is  a  stable  near  the  light- 
house, the  manure  in  it  should  be  protected  from  the  access  of  flies 
by  a  screening  or  some  similar  method.  All  garbage  not  buried 
or  burned  should  be  in  cans,  protected  by  tops,  so  that  the  flies  can 
not  get  in.  All  openings  to  the  house  should  be  protected  by  wire 
netting,  preferably  bronze  wire,  16  mesh  to  the  inch. 

Mosquitoes. — Mosquitoes  are  known  to  convey  such  diseases  as 
malarial  and  yellow  fever  by  biting  a  person  sick  with  this  disease 
and  afterwards  inoculating  other  persons  by  biting  them.  The 
screens  mentioned  above,  properly  applied  to  all  the  openings  of  the 
house,  will  prevent  their  entrance  into  it.  They  breed  usually  in 
stagnant  water.  The  eggs  are  deposited  on  the  surface  of  the  water 
and  are  hatched  out  first  in  the  form  of  what  is  known  as  wiggle 
tails  or  wigglers.  At  the  end  of  about  ten  days  these  wigglers  go 
through  certain  changes  and  become  full-fledged  mosquitoes.  It  is 
important  that  no  water  be  allowed  to  stand  in  containers  about  the 
dwelling  for  a  period  as  long  as  eight  days.  If  there  are  such  con- 
tainers, they  should  be  emptied  every  five  or  six  days  or  protected  by 
a  netting,  so  that  the  mosquitoes  can  not  obtain  access  to  lay  their 
eggs.  Ponds  are  the  principal  breeding  ground  of  mosquitoes,  and  if 
possible  they  should  be  drained  or  oiled  when  near  a  dwelling.  The 
malarial  mosquito  only  bites  about  sundown  or  during  the  night. 

Diet. — In  all  acute  diseases,  especially  those  attended  with  fever, 
the  question  of  diet  is  a  very  important  one,  and  the  main  reliance 
may  be  placed  on  such  food  as  eggs  and  milk.  Thin  soups  may  be 
used,  but  they  contain  very  little  nutrition  and  can  not  be  depended 
upon  to  maintain  the  strength  of  the  sick. 

The  proper  mastication  or  chewing  of  the  food  is  necessary  to 
good  digestion  and  the  maintenance  of  a  healthful  condition.  On 
this  account  the  drinking  of  large  quantities  of  fluid  at  mealtime  is 
objectionable,  as  it  has  a  tendency  to  wash  down  the  solids  before 
they  are  properly  chewed.  It  is  desirable  to  have  the  meals  at  regu- 
lar hours. 

Cleanliness  of  the  person. — A  cold  bath  every  morning  is  probably 
the  best  plan  for  a  person  in  vigorous  health,  but  to  take  one  with 
benefit  there  should  be  a  pleasant  glow  of  exhilaration  afterwards, 
and  it  is  necessary  in  cold  weather  for  the  average  person  to  have  a 
warm  room  in  which  to  take  this  cold  bath.  A  great  many  people 
do  better  with  a  bath  in  tepid  water ;  but  it  is  impossible  to  fix  any 
hard  and  fast  rule  in  these  matters. 

The  presence  of  bedbugs  in  dwellings  is  indicative  of  want  of 
care  and  cleanliness  as  to  bed,  bedclothes,  etc.,  and  means  should  be 
taken  to  exterminate  them  when  they  appear.  A  liberal  application 


POISONS.  9 

of  kerosene  oil  to  the  places  infested  is  probably  the  best  means  of 
killing  them. 

Care  of  the  mouth  and  teeth. — The  teeth  should  be  cleansed  after 
each  meal  with  a  soft  brush,  using  some  mild  dentifrice.  Castile 
soap  makes  an  excellent  cleanser  in  the  absence  of  a  dentifrice. 

For  toothache  caused  by  a  decaying  tooth  often  the  only  cure  is 
pulling  out  the  tooth.  Relief,  however,  can  sometimes  be  obtained 
by  cleaning  out  the  cavity  and  putting  in  two  or  three  drops  of 
creosote  on  a  small  piece  of  cotton.  For  toothache  without  the 
presence  of  a  decayed  tooth  to  cause  it,  the  application  of  heat  to 
the  seat  of  the  pain  will  often  give  relief. 

COMMON  POISONS  AND  THEIR  ANTIDOTES. 

Bichloride  of  mercury  or  corrosive  sublimate. — Give  the  whites 
of  several  eggs  mixed  with  milk  or  water,  or  flour  and  water,  if  eggs 
can  not  be  obtained.  Then  administer  an  emetic  of  a  tablespoonful 
of  mustard  in  warm  water.  The  importance  of  giving  these  remedies 
as  soon  as  possible  .after  taking  of  the  poison  should  be  understood. 

Opium  including  morphine,  laudanum,  and  paregoric. — An  emetic — 
a  tablespoonful  of  mustard  in  warm  water — should  be  immedi- 
ately administered,  and  if  the  patient  becomes  very  drowsy  cold 
water  may  be  dashed  in  his  face  and  he  may  be  beaten  with  a  wet 
towel  and  forced  to  walk  up  and  down.  When  the  respiration  be- 
comes slow  and  irregular,  artificial  respiration  should  be  made,  the 
same  as  is  used  to  restore  the  partially  drowned. 

Carbolic  acid. — Give  grain  alcohol  (not  wood  alcohol)  liberally, 
as  much  as  a  half  glass,  followed  immediately  by  an  emetic.  If  the 
alcohol  is  not  obtainable,  a  half  ounce  of  Epsom  salts  in  warm  water 
may  be  administered;  then  give  the  emetic  consisting  of  a  table- 
spoonful  of  mustard  in  warm  water.  Common  table  salt,  two  table- 
spoonfuls  in  a  glass  of  warm  water,  is  an  excellent  emetic  if  nothing 
else  can  be  secured. 

Arsenic,  including  Paris  green. — Administer  immediately  a  table- 
spoonful  of  mustard  in  a  glass  of  warm  water,  and  repeat  if  vomiting 
is  not  very  free,  as  it  is  all  important  to  empty  the  stomach  at  once. 
Afterwards  give  milk  and  eggs  freely,  or  olive  oil,  one-fourth  pint. 
A  tablespoonful  of  common  washing  soda  in  a  half  glass  of  water 
will  often  relieve  the  symptoms. 

USE  OF  CLINICAL  THERMOMETER. 

Place  bulb  of  mercury  in  mouth  under  tongue  for  five  minutes.  If 
it  registers  over  101  degrees,  send  for  physician.  Stay  in  bed  until 
he  arrives.  See  that  it  registers  less  than  97  before  using. 


10  MEDICAL  HANDBOOK. 

MALARIAL  FEVER. 

Malarial  fever  is  an  endemic  infectious  disease,  caused  by  a  para- 
site of  the  blood.  The  disease  is  transmitted  to  man  (inoculated)  by 
the  bite  of  certain  kinds  of  mosquitoes,  of  the  genus  Anopheles. 

It  is  a  disease  of  warm  and  temperate  regions;  very  prevalent 
and  of  severe  type  in  hot  countries,  especially  along  the  seacoast 
and  basins  of  rivers,  but  gradually  declining  in  extent  and  virulence 
in  proportion  to  the  distance  on  either  side  from  the  Equator.  In 
the  Tropics  the  disease  is  constantly  prevalent.  In  the  cooler,  or 
temperate  regions,  as,  for  example,  along  the  coast  of  the  Central 
Atlantic  States,  it  is  active  only  during  summer  and  autumn.  It  is 
seldom  developed  at  a  lower  temperature  than  60°  F.  (15.5°  C.), 
and  even  in  the  hot  climates  malaria  is  probably  never  contracted 
far  away  from  land.  The  disease  is  said  to  be  most  frequently  con- 
tracted during  the  night,  just  after  sunset  and  just  before  sunrise 
being  the  most  dangerous  periods.  It  is,  therefore,  very  important 
in  infected  localities  not  to  permit  the  men  to  go  ashore  nor  to  allow 
them  to  sleep  on  deck  if  the  vessel  is  lying  near  the  land ;  or,  if  they 
must  sleep  on  deck  or  other  exposed  places,  to  provide  suitable  pro- 
tection by  means  of  blankets  and  properly  constructed  mosquito  bars. 

There  are  different  varieties  and  types  of  malarial  intermittent 
fever:  (1)  Quotidian,  when  the  paroxysm 'occurs  every  day;  (2) 
tertian,  when  it  occurs  every  other  day;  and  (3)  quartan,  when  it 
occurs  every  fourth  day.  The  disease  is  popularly  known  as  "  fever 
and  ague,"  "  chills  and  fever,"  "  the  shakes,"  etc.  It  is  characterized 
by  recurring  paroxysms,  consisting  as  a  rule  of  three  distinct 
stages :  The  cold,  the  hot,  and  the  sweating  stage.  The  attack  may 
be  sudden  or  it  may  be  preceded  by  a  feeling  of  uneasiness,  a  desire 
to  stretch  the  limbs  and  yawn,  headache,  loss  of  appetite,  and  some- 
times by  vomiting.  The  chill  may  be  of  any  degree  of  severity. 
Patients  sometimes  complain  only  of  chilliness  or  of  a  creeping  sen- 
sation of  coldness  over  the  back.  More  frequently  the  chill  is  well 
marked;  the  feeling  of  cold  spreads  all  over  the  body,  the  teeth 
chatter,  the  patient  shivers,  and  his  whole  body  shakes.  This  cold 
stage  may  last  from  a  few  minutes  to  an  hour,  or  longer. 

The  hot  stage  gradually  comes  on  as  the  cold  stage  subsides,  and 
soon  there  is  a  feeling  of  intense  heat.  The  face  becomes  flushed, 
the  pulse  full  or  bounding,  the  headache  continues,  and  the  patient 
is  in  high  fever.  This  stage  may  last  from  half  an  hour  to  four  or 
five  hours,  when  perspiration  appears,  first  on  the  forehead  and 
gradually  over  the  entire  body,  and  the  sweating  stage  is  fully  estab- 
lished. With  the  appearance  of  perspiration  the  fever  declines,  the 
distressing  symptoms  gradually  cease,  the  patient  experiences  a  feel- 
ing of  great  relief,  and  soon  falls  into  a  refreshing  sleep.  The  dura- 


DISEASES.  11 

tion  of  the  sweating  stage  varies  from  one  to  three  hours.  It  may 
be  very  profuse  or  very  slight.  At  the  end  of  the  sweating  stage 
the  patient  may  be  greatly  prostrated  or  may  feel  quite  well,  and 
able  to  be  up  and  about  until  the  beginning  of  the  cold  stage  of  the 
next  fit,  twenty-four,  forty-eight,  or  seventy-two  hours  from  the 
beginning  of  the  first. 

There  are  three  varieties  of  malarial  fever — intermittent,  remit- 
tent, and  a  very  severe  type  known  as  pernicious  malarial  fever. 

In  the  intermittent  the  paroxysms  may  recur  at  irregular  intervals, 
the  cold  stage  may  be  absent,  the  fever  may  come  on  gradually  and 
decline  to  normal  in  the  same  manner. 

When  the  attacks  are  prolonged,  and  when  instead  of  declining  to 
normal  there  may  be  only  a  slight  fall  in  the  temperature  and  slight 
sweating,  the  fever  is  called  remittent  fever. 

Pernicious  malarial  fever,  as  the  name  indicates,  is  a  very  fatal 
disease.  It  occurs  chiefly  in  hot  climates,  but  is  occasionally  met  with 
in  temperate  regions.  It  may  be  preceded  by  an  apparently  mild  'at- 
tack of  intermittent  fever  or  the  patient  may  be  taken  suddenly  with 
intense  headache,  high  fever,  wild  or  perhaps  muttering  delirium, 
rapidly  passing  into  unconsciousness,  and  death  may  occur  within 
a  few  hours  from  the  beginning  of  the  attack. 

In  another  form  of  the  disease  the  attack  begins  with  extreme  cold- 
ness of  the  surface  of  the  body,  with  vomiting,  or  with  severe  diar- 
rhea or  dysentery,  and  the  patient  may  die  from  collapse. 

There  is  also  a  hemorrhagic  form  in  which  bleeding  may  occur 
from  the  nose,  mouth,  or  gums.  The  urine  may  be  bloody  or  quite 
dark  in  color,  in  some  cases  almost  black.  In  tropical  Africa  and 
other  hot  countries  where  the  disease  prevails  it  is  known  as  "  black- 
water  fever." 

Hemorrhages,  however,  may  occur  in  any  severe  or  prolonged  form 
of  malarial  infection,  and  bloody  urine  (malarial  hematuria)  is  not 
infrequently  met  with. 

Treatment. — Quinine  is  the  remedy,  and  quinine  also  acts  as  a  pre- 
ventive. In  going  to  a  malarial  region,  treatment  should  be  com- 
menced several  days  before  arriving  at  port.  To  each  man  on  board 
should  be  given  at  least  10  grains  (0.6  gm.)  of  quinine  daily  for  a 
period  of  one  week.  The  allowance  may  then  be  reduced  to  5  grains 
(0.3  gm.)  or  even  to  3  grains  (0.2  gm.)  a  day.  The  bowels  should 
be  kept  freely  open. 

If  a  chill  occur,  the  patient  should  at  once  be  wrapped  in  blankets 
and  given  hot  drinks.  During  the  hot  stage,  cold  drinks,  lemonade, 
etc.,  may  be  given.  As  soon  as  the  sweating  stage  begins,  10  or  15 
grains  (0.6  gm.  to  1  gm.)  of  quinine  should  be  given,  and  thereafter  5 
grains  (0.3  gm.)  every  six  hours,  for  two  or  three  days,  and  then  con- 


12  MEDICAL,  HANDBOOK. 

tinued  in  smaller  doses,  say  3  grains  (0.2  gm.)  three  times  daily,  for 
the  next  two  weeks. 

If  the  chill  is  severe,  or  if  the  surface  of  the  body  is  very  cold,  hot- 
water  bottles  or  heated  bricks  or  stones  wrapped  in  cloth  or  in  a 
separate  piece  of  blanket  should  be  placed  to  the  feet.  Mustard 
plasters  may  also  be  applied  to  the  extremities  and  over  the  region 
of  the  heart,  and  hot  stimulating  drinks  should  be  given. 

If  vomiting  occur,  a  mustard  plaster  may  also  be  placed  over  the 
region  of  the  stomach,  above  the  navel,  and  cracked  ice  may  be  given 
by  the  mouth.  Headache  may  be  relieved  by  cold  applications. 

If  the  hot  stage  is  severe,  a  tepid  bath  may  be  given  in  a  tub  or  by 
means  of  a  sponge.  If  the  temperature  is  very  high,  105°  or  106°  F. 
(40.5°  or  41.1°  C.),  a  cold  bath  should  be  given. 

In  remittent  and  other  severe  types  of  malarial  fever  the  treatment 
should  be  more  active.  No  time  should  be  lost  in  giving  the  quinine ; 
30  or  15  or  20  grains  (0.6  gm.  to  1.3  gm.)  should  be  given  imme- 
diately, and  along  with  this,  if  the  bowels  are  not  freely  open,  a  calo- 
mel tablet,  one-tenth  grain  each,  should  be  given  every  half  hour  until 
10  have  been  taken.  After  the  bowels  move,  the  quinine  should  be 
continued  in  5-grain  (0.3  gm.)  doses  every  four  or  five  hours. 

The  symptoms  and  signs  of  typical  malarial  intermittent  fever  are 
so  striking  that  they  can  hardly  be  mistaken  for  anything  else.  It 
must  not  be  forgotten,  however,  that  there  are  typical  and  irregular 
forms  of  malarial  fever,  and  that  they  may  be  mistaken  for  other 
diseases,  such  as  tubercle  (consumption)  of  the  lungs,  abscess  of  the 
lungs  or  of  the  liver  or  any  part  of  the  body,  or  the  result  of  the 
passing  of  a  catheter,  all  of  which  produce  chills  or  chilliness  and 
fever. 

Some  forms  of  remittent  or  continued  remittent  malarial  fever 
may  be  difficult  to  distinguish  from  typhoid  fever.  The  remittent 
type  may  be  mistaken  for  yellow  fever. 

Quinine  is  the  remedy  for  any  form  of  malarial  fever.  If  the 
fever  does  not  yield  to  full  doses  of  quinine,  it  is  probably  not  mala- 
rial. At  any  rate  this  is  the  most  practical  method  for  determining 
the  question  as  to  whether  the  fever  is  malarial  or  not.  In  the  hos- 
pital or  laboratory  the  diagnosis  is  made  by  microscopical  examina- 
tion of  the  blood. 

The  diet  in  any  form  of  acute  fever  should  be  light,  liquid,  and 
nourishing;  and  if  there  is  much  prostration,  stimulants  will  be  re- 
quired. Solid  food  should  not  be  allowed. 

MEASLES. 

Measles  is  an  acute  infectious  disease,  which  most  commonly  at- 
tacks children  but  may  occur  in  adults.  It  usually  spreads  from  per- 
son to  person  by  exposure  to  a  patient  with  the  disease,  as  going  into 


DISEASES.  13 

the  room  where  he  is  sick,  riding  in  the  same  street  car,  or  being  in 
the  same  schoolroom.  It  generally  makes  its  appearance  from  twelve 
to  fourteen  days  after  exposure.  One  attack  is  usually  a  protection 
against  a  second  one. 

It  usually  begins  with  the  symptoms  of  an  ordinary  cold.  There 
may  be  an  initial  chill;  the  patient's  face  looks  flushed  and  some- 
times slightly  swollen  about  the  nose  and  eyes,  and  the  eyes  are  red- 
dened. There  may  be  a  tendency  to  sneeze,  and  an  examination  of 
the  throat  will  disclose  a  reddening  of  the  mucous  membrane.  The 
rash  often  appears  first  in  the  throat.  Some  cough  may  be  present 
at  the  onset,  with  more  or  less  headache.  Fever  is  generally  present 
with  the  onset  of  these  symptoms.  The  eruption  on  the  skin  devel- 
ops on  the  third  or  fourth  day  of  the  fever.  It  may  be  most  marked 
on  the  forehead  or  about  the  ears,  looking  like  fleabites,  and  gradu- 
ally spreads  over  the  entire  body.  The  patient  has  considerable 
cough  with  expectoration.  In  children  there  is  some  liability  to  a 
form  of  pneumonia  called  broncho-pneumonia,  which  renders  the 
disease  much  more  dangerous.  It  may  also  have  the  complication  of 
diarrhea  and  vomiting,  due  to  implication  of  the  bowels  and  stomach. 

As  soon  as  a  case  is  discovered  it  should  be  put  in  bed  and  isolated 
in  a  room,  from  which  children  should  be  excluded  and  only  those 
adults  admitted  who  are  directly  concerned  in  the  care  of  the  case. 

It  is  necessary  to  protect  the  patient  from  becoming  chilled,  and 
he  should  not  be  exposed  to  drafts,  but  fresh  air  should  be  admitted 
to  the  room.  If  the  weather  is  cold,  he  should  be  provided  with 
plenty  of  covering. 

The  treatment  of  an  ordinary  case  of  measles  is  practically  nil,  as 
little  or  no  medication  is  required.  If  there  is  much  irritation  of  the 
eyes,  it  is  well  to  have  the  room  darkened  and  to  wash  out  the  eyes 
with  a  saturated  solution  of  boric  acid  in  warm  water.  Take  a  glass 
of  warm  water  and  put  into  it  all  the  boric  acid  it  will  dissolve  and 
use  it  as  a  wash  for  the  eyes,  keeping  it  covered  to  prevent  dust  or 
other  impurities  getting  into  the  solution.  Everything  applied  to 
the  eyes  should  be  scrupulously  clean. 

If  the  skin  is  dusky  and  the  eruption  is  not  well  marked,  the  pa- 
tient may  be  enveloped  in  sheets  or  blankets  wrung  from  hot  water, 
but  care  must  be  exercised  that  he  does  not  become  too  rapidly  chilled 
afterwards.  Only  sufficient  covering  should  be  used  to  render  the 
patient  comfortable. 

If  the  cough  is  very  troublesome,  a  tablet  of  brown  mixture  may  be 
given  three  or  four  times  a  day. 

After  the  eruption  has  disappeared  and  the  peeling  of  the  skin  has 
begun,  the  patient  should  bathe  daily  in  order  that  the  skin  may  be 
freed  from  the  scales.  Children  should  not  be  allowed  to  approach 
the  patient  until  after  this  scaling  has  entirely  ceased. 


14  MEDICAL.  HANDBOOK. 

During  the  period  of  the  disease  the  patient  may  be  fed  on  broths, 
milk,  soft-boiled  eggs,  etc. 

After  recovery  of  a  case  of  measles,  the  bedding  should  be  disin- 
fected by  boiling  twenty  minutes  or  by  soaking  in  a  bichloride  of 
mercury  solution,  1  to  1,000,  for  two  or  three  hours. 

The  hangings  in  the  room  and  the  rug  or  carpet,  if  any,  should 
be  disinfected,  if  possible ;  but  if  disinfection  is  not  practicable,  they 
should  be  hung  out  in  the  sunshine  and  well  beaten  before  being  used 
again.  The  room  should  be  thoroughly  cleaned  and  p.ired  for  several 
days. 

MUMPS. 

Mumps  is  an  acute  infectious  disease  usually  affecting  children, 
but  may  occur  in  adults.  It  affects  the  parotid  gland,  which  is 
situated  just  below  the  ear  on  each  side.  It  is  usually  conveyed  by 
contact  from  one  patient  to  another.  Hence,  the  patient  should  be 
isolated  in  a  room,  and  children  should  not  be  exposed  to  the  dis- 
ease. Only  the  adults  directly  in  charge  of  the  case  should  be  ad- 
mitted to  the  room  unless  they  have  been  protected  by  a  previous 
attack.  An  attack  usually  comes  on  about  fifteen  days  after  the 
exposure  to  the  disease. 

The  chief  symptoms  are  pain  and  swelling  in  the  parotid  region 
under  the  ear.  Movements  of  the  jaw,  such  as  chewing  and  talking, 
will  be  painful.  Swelling  may  occur  on  one  or  both  sides,  but  nearly 
always  both  are  involved.  It  is  usually  worst  about  the  third  day, 
and  may  gradually  disappear  after  that.  It  is  usually  a  very  mild 
disease,  but  swelling  of  the  testicle  is  a  frequent  complication  in  the 
male. 

Treatment. — Light  diet,  such  as  broths,  eggs,  milk,  rice  puddings, 
etc.,  should  be  given.  Sour  food  and  acid  drinks  will  be  found  to 
give  considerable  pain  if  taken  in  the  mouth ;  hence,  they  should  be 
avoided.  Hot  applications  may  be  placed  over  the  swollen  glands  if 
there  is  very  much  pain.  No  internal  medicines  are  indicated.  If 
the  bowels  are  constipated,  a  tablespoonful  of  Epsom  salts  may  be 
administered  with  benefit. 

After  recovery  of  a  case  of  mumps,  the  bedding  should  be  dis- 
infected by  boiling  twenty  minutes  or  by  soaking  in  a  bichloride  of 
mercury  solution,  1  to  1,000,  for  two  or  three  hours. 

The  hangings  in  the  room  and  the  rug  or  carpet,  if  any,  should  be 
disinfected,  if  possible;  but  if  disinfection  is  not  practicable,  they 
should  be  hung  out  in  the  sunshine  and  well  beaten  before  being  used 
again.  The  room  should  be  thoroughly  cleaned  and  aired  for  several 
days. 


DISEASES.  15 

SMALLPOX. 

Smallpox  is  an  acute,  contagious  disease,  characterized  by  an  initial 
fever  and  successive  stages  of  eruption.  It  spreads  rapidly  among 
persons  unprotected  by  vaccination.  It  may  be  communicated  by  the 
breath,  by  exhalations  from  the  skin,  by  clothing,  or  by  anything  that 
has  been  in  contact  with  a  person  suffering  from  the  disease.  It  is 
very  contagious  during  the  latter  stage  of  eruption,  and  especially 
during  the  period  of  convalescence  when  the  dried  pus  scales  become 
detached  from  the  skin  and  in  the  form  of  dry  powder  or  dust  settle 
on  everything  about  the  room  or  compartment,  and  may  be  conveyed 
not  only  to  all  parts  of  the  ship  or  light  station,  but  to  any  part  of 
the  world  to  which  the  ship  is  bound. 

After  a  period  of  incubation  of  from  eight  to  fourteen  days,  occa- 
sionally longer,  the  disease  begins  suddenly,  usually  with  a  chill, 
always  with  severe  pain  in  the  back  and  loins,  intense  headache,  and 
high  fever.  Vomiting  occurs  in  many  cases.  The  bowels  may  or 
may  not  be  constipated. 

About  the  end  of  the  third  day  or  on  the  fourth  day  a  papular 
eruption  appears  on  the  forehead,  and  frequently  on  the  lips  and  the 
wrists,  occasionally  in  the  mouth  and  throat,  and  gradually  extends 
to  other  parts  of  the  body.  The  eruption  begins  as  a  bright  red  dot 
or  spot  slightly  elevated  above  the  surrounding  skin,  enlarging  until 
the  second  day,  when  it  forms  a  papule.  The  papule  is  hard  to  the 
touch,  feels  like  shot  under  the  skin.  As  soon  as  the  eruption  appears 
the  temperature  begins  to  fall,  and  the  distressing  symptoms  subside. 
On  the  fifth  or  sixth  day  a  small  vesicle,  with  a  depression  of  the 
center,  appears  on  the  top  of  each  papule.  The  vesicles  gradually 
become  distended,  the  depressed  centers  rounded  out,  and  about  the 
eighth  or  ninth  day  the  change  is  completed  and  the  vesicles  become 
pustules.  They  have  a  yellowish  gray  appearance  and  each  pustule 
is  surrounded  by  a  red  border.  The  skin  between  them  is  swollen, 
the  eyes  may  be  closed.  During  this  change  the  temperature  rises 
again,  secondary  fever  sets  in,  the  chief  symptoms  return,  and  a  day 
or  two  later  another  change  begins.  The  pustules  break,  matter  oozes 
out,  crusts  form,  first  on  the  face  and  then  over  other  parts  of  the 
body,  following  the  order  of  the  appearance  of  the  eruption.  The 
secondary  fever  may  be  quite  high  in  the  beginning,  but  gradually 
declines  as  the  pustules  change  into  crusts,  and  in  favorable  cases 
seldom  lasts  more  than  two  or  three  days.  The  crusts  then  rapidly 
dry  and  fall  off,  leaving  red  spots  on  the  skin  and  here  and  there  the 
characteristic  pockmarks  or  pits.  The  healing  of  the  pustules  is 
usually  attended  by  troublesome  itching. 

In  some  cases  a  diffuse  redness  of  the  skin  or  red  spots  appear  on 
the  abdomen,  or  on  the  side  of  the  chest,  or  on  the  inner  surface  of 


16  MEDICAL,  HANDBOOK. 

the  thighs  as  early  as  the  second  day,  but  the  distinctive  papular 
eruption  makes  its  appearance,  as  stated,  at  the  end  of  the  third  or 
on  the  fourth  day  and  nearly  always  begins  on  the  forehead. 

In  the  confluent  form  of  smallpox  the  eruption  may  appear  a  day 
earlier  and  all  the  symptoms  are  more  severe.  The  pustules  run 
together  and  form  large  brownish  scabs,  chiefly  on  the  face  and  head, 
but  also  on  the  hands  and  feet.  The  face  and  neck  are  greatly  swol- 
len, the  eyes  are  closed,  the  features  are  distorted.  The  patient  com- 
plains of  tension  and  burning  of  the  skin ;  there  is  much  thirst,  The 
eruption  may  also  appear  in  the  mouth  and  throat.  The  secondary 
fever  is  high.  Delirium  may  be  quite  marked.  In  fatal  cases  the 
pulse  becomes  rapid  and  feeble^  and  death  occurs  about  the  tenth  or 
eleventh  day  or  later. 

In  favorable  cases,  about  the  eleventh  or  twelfth  day  the  pustules 
begin  to  break.  The  matter  dries  and  forms  crusts  which  slowly  fall 
off,  leaving  the  skin  quite  red  and  in  many  cases  dreadfully  scarred 
and  pitted. 

The  crusts  begin  to  drop  off  about  the  fourteenth  day,  but  the  proc- 
ess of  desquamation  may  not  be  completed  until  the  end  of  the  third 
or  fourth  week,  and  the  fever  may  persist  during  that  period.  There 
is  a  milder  form  of  smallpox  called  varioloid,  in  which  the  symptoms 
are  usually  milder  and  of  shorter  duration.  Varioloid  occurs  in  per- 
sons who  have  been  vaccinated.  Sometimes  the  eruption  begins  on  the 
feet.  In  some  cases  it  is  confined  to  the  feet  and  hands.  Occasionally 
the  eruption  is  extensive  and  the  symptoms  are  severe. 

The  most  severe  type  of  smallpox  is  the  hemorrhagic  (bloody).  It- 
occurs  in  two  forms.  In  one  the  case  goes  on  in  the  usual  way  until 
about  the  ninth  or  tenth  day,  when  blood  makes  its  appearance  in  the 
pock.  This  form  is  sometimes  called  black  smallpox.  In  the  other 
form  the  eruption  may  be  blood-colored  from  the  second  day,  and 
bleeding  may  take  place  from  the  nose  or  mouth  or  from  the  rectum. 
The  face  is  greatly  swollen  and  the  eyes  are  deeply  bloodshot.  Death 
occurs  during  the  first  week,  sometimes  as  early  as  the  second  day. 

Before  the  characteristic  eruption  appears  it  is  frequently  very 
difficult  to  determine  the  existence  of  smallpox.  It  is  easily  con- 
founded with  other  eruptive  diseases.  The  important  points  to 
remember  are  the  intense  pain  in  the  back,  the  high  fever,  and 
bounding  pulse,  all  of  which  precede  the  eruption,  and  that  when 
the  eruption  appears  the  fever  and  all  the  severe  symptoms  subside. 
The  temperature  before  the  eruption  may  be  up  to  105°  or  106°  F. 
(40.5°  or  41.1°  C.).  When  the  eruption  appears  it  begins  to  decline 
and  within  twenty-four  or  thirty-six  hours  is  down  to  about  100°  F. 
(37.7°  C.).  When  the  secondary  fever  sets  in  the  temperature  rises 
again. 


DISEASES.  17 

Treatment. — The  patient  should  be  placed  in  a  cool,  well- ventilated 
room,  and  strictly  isolated ;  and  every  person  at  the  light  station  or 
on  board  the  ship  should  be  immediately  vaccinated.  No  one  should 
be  allowed  to  come  in  contact  with  him  except  the  nurse  or  attendant, 
and  the  nurse  or  attendant  should  not  be  allowed  to  come  in  contact 
with  other  persons.  While  in  immediate  attendance  on  the  sick  he 
should  wear  overalls  and  jumper,  and  a  head  covering,  to  be  removed 
when  he  leaves  the  room,  and  immediately  put  on  again  when  he 
returns.  Separate  dishes  and  necessary  utensils  should  be  provided. 
The  food  should  be  placed  at  a  convenient  place  near  the  door  of  the 
sick  room  where  the  nurse  can  come  and  get  it.  Nothing  should  be 
allowed  in  the  room  except  the  articles  absolutely  necessary.  The 
soiled  clothing  should  be  wrapped  in  a  clean  sheet  (or  in  a  sheet  that 
has  been  dipped  in  a  1  to  1,000  solution  of  bichloride  of  mercury), 
and  the  bundle  placed  in  a  kettle  of  water  and  thoroughly  boiled. 
If  there  is  a  sufficient  supply  of  bedclothing  the  soiled  articles  should 
be  destroyed  by  fire  (burned).  The  patient  must  be  kept  thoroughly 
clean.  Good  nursing  is  very  important. 

In  the  early  stage,  when  the  fever  is  high,  place  the  patient  in  a 
cold  bath,  or  give  him  a  cold  sponge  bath,  note  the  temperature  of  the 
body,  and  repeat  the  bath  every  three  hours  if  the  thermometer  regis- 
ters above  103°  F.  (39.4°  C.).  If  the  bowels  are  constipated,  give 
small  doses  of  Epsom  salts,  2  teaspoonfuls,  every  two  or  three  hours. 

The  food  should  be  soft  and  nourishing  and  given  at  regular  inter- 
vals. Cold  drinks,  lemonade,  barley  water,  etc.,  may  be  freely  given. 

The  pain  and  tension  in  the  skin  may  be  relieved  by  cold  applica- 
tions. A  piece  of  lint,  wet  with  a  cold  2  per  cent  solution  of  carbolic 
acid,  may  be  applied  to  the  face  and  frequently  renewed.  Holes 
should  be  cut  into  the  lint  corresponding  to  the  eyes,  nose,  and  mouth. 
When  the  pustules  begin  to  form  it  is  a  good  plan  to  touch  each  one 
with  tincture  of  iodine  (a  camel 's-hair  brush  may  be  used  for  the 
purpose) ,  and  a  day  later  to  puncture  them  with  the  point  of  a  needle. 
The  needle  should  first  be  boiled,  and  the  point  should  then  be  dipped 
in  tincture  of  iodine  before  making  the  puncture.  When  crusts  begin 
to  form,  olive  oil  or  glycerin  should  be  applied.  If  the  hair  is  long 
it  should  be  cut  short  early  in  the  disease  before  the  pustular  stage 
begins.  The  eyes  must  be  carefully  cleansed  several  times  a  day,  else 
blindness  may  follow.  A  solution  of  boric  acid,  5  grains  to  a  fluid 
ounce  of  water,  is  a  good  eyewash.  The  mouth,  throat,  and  nose  also 
require  attention.  A  saturated  solution  of  boric  acid  may  be  used 
as  a  mouth  wash  and  gargle. 

When  the  crusts  and  scabs  drop  off  they  should  be  carefully  gath- 
ered up  and  burned.  The  patient  should  then  have  a  daily  bath  with 
soap  and  water.  When  the  case  is  ended  the  room  and  all  exposed 
21824°— 12 2 


18  MEDICAL,  HANDBOOK. 

articles  must  be  disinfected  by  burning  sulphur  (4  pounds  to  every 
1,000  cubic  feet  of  air  space). 

On  shipboard  if  near  port  when  the  disease  breaks  out  the  ship 
should  be  taken  direct  to  the  quarantine  station,  where  the  patient 
may  be  taken  care  of  and  the  ship  disinfected. 

DYSENTERY. 

Dysentery,  or  bloody  flux,  as  it  is  sometimes  called,  is  an  affection — 
an  inflammation  and  ulceration — of  the  mucous  membrane  of  the 
large  bowel.  It  occurs  in  different  degrees  of  severity.  It  may  be 
acute  or  chronic.  There  are  different  varieties.  Its  severest  form  is 
met  with  in  tropical  countries,  where  it  frequently  occurs  in  wide- 
spread epidemics.  Epidemics  also  occur  in  temperate  regions.  Spo- 
radic cases  may  be  found  almost  everywhere.  The  disease  prevails 
in  summer  and  autumn.  It  may  attack  an  entire  ship's  crew. 

Bad  food,  unripe  fruit,  impure  drinking  water,  exposure  to  cold 
and  dampness,  while  probably  not  in  themselves  the  direct  cause  of 
dysentery,  doubtless  favor  the  operation  of  other  causes. 

Symptoms. — The  onset  may  be  sudden  or  gradual.  There  may 
or  may  not  be  chills  or  chilliness.  There  is  usually  some  feverish- 
ness.  The  tongue  is  furred  and  moist,  but  soon  becomes  red  and  dry 
or  brownish  and  glazed. 

The  first  stools  may  be  like  those  of  an  ordinary  diarrhea.  After 
a  day  or  two,  or  maybe  within  a  few  hours,  these  are  replaced  by 
small  mucous  stools  frequently  mixed  with  blood  and  small  particles 
of  fecal  matter.  Soon  the  evacuations  consist  of  mucus  alone,  or  of 
blood  and  mucus,  or  of  a  jelly-like  matter  and  small  white  clumps 
of  mucus.  Later  they  may  be  shreddy,  and  brownish  or  greenish  in 
color.  Patient  complains  of  cramps  and  "colicky"  pains  in  his 
belly;  a  burning  sensation  in  the  rectum,  with  a  feeling  as  if  some- 
thing must  be  expelled,  and  of  a  constant  desire  to  go  to  stool.  The 
evacuations  may  number  from  ten  to  twenty,  or  forty  to  fifty,  or 
even  a  hundred  or  more  a  day,  according  to  the  severity  of  the  case. 
The  quantity  of  each  may  not  exceed  a  teaspoonful. 

In  mild  cases  there  is  a  gradual  change  to  normal,  and  patient  may 
recover  after  a  period  of  a  week  or  ten  days.  Severer  cases  continue 
for  several  weeks  or  longer  and  then  recover,  or  become  chronic  and 
incurable,  or  death  may  occur  from  general  weakness. 

Tropical  dysentery,  the  variety  which  occurs  most  frequently  and 
in  epidemic  form  in  tropical  or  subtropical  regions,  but  also  occa- 
sionally in  temperate  climates,  is  said  to  be  produced  by  a  micro- 
organism which  enters  the  system  in  drinking  water. 

The  symptoms  in  this  form  of  dysentery  are  similar  to  those 
already  described.  The  burning  sensation  and  bearing-down  pain, 
however,  are  less  marked.  The  stools  are  less  frequent,  but  they 


DISEASES.  19 

are  larger  and  more  watery ;  at  times  more  like  diarrhea  than  typical 
dysentery.  The  disease  in  favorable  cases  runs  a  course  of  from 
six  to  twelve  weeks.  Recovery  is  always  slow.  Death  may  occur 
from  exhaustion,  or  from  abscess  of  the  liver,  which  is  a  common 
complication.  In  the  most  fatal  epidemics  the  course  of  the  disease 
is  very  rapid.  Death  sometimes  occurs  within  a  few  hours. 

Treatment. — Rest  in  bed.  If  possible,  the  patient  should  use  the 
bedpan  instead  of  the  commode  or  closet,  so  as  to  insure  the  greatest 
amount  of  rest,  which  is  very  important.  Stop  all  solid  food.  Give 
2  tablespoonfuls  (30  c.  c.)  of  castor  oil  and  15  drops  of  laudanum 
in  one  dose,  and,  if  necessary,  repeat  the  dose  in  six  hours,  or  give 
smaller  doses  at  intervals  of  four  hours.  After  the  bowels  have 
been  thoroughly  cleared  out,  a  pill  of  camphor  and  opium  should 
be  given  every  three  hours.  Hot"  applications  should  be  placed  on 
the  abdomen.  The  bearing-down  pain  and  the  burning  sensation 
may  be  relieved  by  washing  out  the  rectum  with  a  pint  of  warm 
water  and  by  injecting  2  ounces  of  thin  starch  containing  25  or  30 
drops  of  laudanum. 

In  place  of  the  castor  oil,  Epsom  salts  may  be  given  in  tablespoon- 
ful  doses,  repeated  every  two  hours  until  a  free  and  large  action  of 
the  bowels  results,  and  then  the  pill  of  camphor  and  opium  given 
every  three  hours.  Or,  instead  of  the  camphor  and  opium  pills, 
bismuth  subnitrate  may  be  given  in  30  or  40  grain  (2  gm.  or  2.6 
gm.)  doses. 

After  two  or  three  days,  if  the  disease  continues,  the  castor  oil  or 
the  Epsom  salts  may  be  repeated,  and  after  its  effect  is  produced, 
the  same  line  of  treatment  continued. 

The  diet  should  be  limited  to  the  lightest  articles,  such  as  thin 
porridge,  milk,  and  broths.  And  even  in  the  lightest  cases  the  pa- 
tient should  be  kept  warm  in  bed. 

The  best  means  of  protection  or  prevention  is  to  keep  the  body  in 
sound  condition.  If  the  disease  occurs  among  a  ship's  crew,  the 
healthy  men  should  be  very  careful  not  to  catch  cold,  and  to  avoid 
errors  in  eating  and  drinking.  Sudden  changes  of  temperature 
should  be  guarded  against  by  a  proper  supply  of  clothing.  The 
drinking  water  should  be  boiled. 

SUNSTROKE. 

The  term  sunstroke  denotes  a  sudden  attack  of  illness  from  expo- 
sure or  prolonged  exposure  to  the  rays  of  the  sun;  but  the  same 
condition  may  be  produced  in  hot  weather  by  exposure  to  high 
temperature  not  in  the  direct  rays  of  the  sun,  particularly  if  the 
person  is  engaged  at  hard  work  in  close  quarters.  Stokers  on  steam- 
ships are  sometimes  affected  by  the  heat  of  the  furnace.  Men  debili- 


20  MEDICAL  HANDBOOK. 

tated  from  or  addicted  to  the  excessive  use  of  stimulants  are  more 
apt  to  suffer  than  those  of  temperate  habits. 

Sunstroke  occurs  in  two  forms:  Heat  stroke  (heat  fever),  in  which 
the  temperature  of  the  body  is  very  high,  and  heat  prostration  or 
heat  exhaustion,  in  which  the  surface  of  the  body  is  cool,  sometimes 
considerably  below  normal.  The  difference  is  very  important  because 
of  the  different  treatment  required. 

In  severe  cases  of  heat  stroke,  the  patient  may  be  stricken  down 
in  a  state  of  unconsciousness  and  die  instantly  or  within  an  hour  or 
two.  In  other  cases  there  may  be  intense  headache,  dizziness,  marked 
restlessness,  nausea  and  vomiting,  and  hot  "  burning "  skin.  The 
thermometer  may  register  105°  F.  Pulse  is  full  and  may  be  slow  or 
fast.  Breathing  is  labored,  may  be  sighing  or  rattling.  Patient  soon 
becomes  unconscious,  the  stupor  deepens,  and  death  may  occur  within 
24  hours;  or  the  temperature  may  drop,  consciousness  may  return, 
and  the  patient  get  well. 

In  heat  prostration,  as  already  stated,  the  surface  of  the  body  is 
cool,  the  pulse  rapid  and  feeble,  and  there  is  a  feeling  of  general 
weakness.  There  may  be  only  slight  faintness  and  nausea,  and  under 
prompt  treatment  patient  may  rapidly  recover,  or,  on  the  other  hand, 
there  may  be  complete  loss  of  consciousness  and  a  rapid  and  fatal 
termination  from  exhaustion. 

Treatment. — In  heat  stroke  (heat  fever)  the  temperature  of  the 
body  should  be  reduced  as  rapidly  as  possible.  Remove  the  patient 
to  the  coolest  and  best- ventilated  part  of  the  ship  or  station.  Place 
him  in  a  cold-water  bath,  add  ice,  rub  the  body  with  the  blocks  of  ice, 
apply  iced  water  with  ice  cap  to  his  head ;  and  keep  up  the  treatment 
until  the  temperature,  as  shown  by  the  thermometer  in  the  rectum, 
is  reduced  to  100°  F.  If  the  temperature  rise  again,  repeat  the 
treatment.  If  symptoms  of  exhaustion  follow  the  reduction  of  the 
temperature,  stimulants  should  be  given — strychnia  sulphate,  one- 
fortieth  grain. 

In  heat  prostration,  with  cool  skin,  weak  and  rapid  pulse,  stimu- 
lants and  friction  are  required.  Give  strychnia  sulphate,  one-fortieth 
grain,  rub  the  surface  of  the  body  and  the  extremities,  place  hot- 
water  bottles  to  the  feet,  and  cover  the  body  with  blankets.  If  the 
head  is  hot,  apply  cold  water  to  the  forehead.  If  vomiting  occur, 
inject  the  stimulants  into  the  rectum.  Apply  mustard  over  the  region 
of  the  stomach.  Mustard  may  also  be  applied  to  the  feet. 

DIARRHEA. 

Acute  diarrhea  is  caused  by  acute  inflammation  or  by  irritation 
of  the  intestines.  It  may  occur  as  a  complication  in  many  different 
diseases.  It  is  usually  one  of  the  symptoms  of  typhoid  fever.  It  is 
not  infrequently  met  with  in  severe  cases  of  malaria.  It  is  called 


DISEASES.  21 

functional  or  simple  diarrhea  when  it  occurs  independently  of  any 
other  appreciable  disease.  It  may  be  caused  by  exposure  to  cold  or 
by  errors  in  diet. 

In  simple  diarrhea  there  may  or  may  not  be  griping  and  colicky 
pains.  In  the  more  severe  forms  the  tongue  is  coated  and  there  is 
some  fever.  Thirst  is  marked  in  proportion  to  the  size  and  frequency 
of  the  thin  or  watery  discharges.  If  the  rectum  is  affected,  there  is  a 
constant  desire  to  go  to  stool,  and  a  burning  sensation  and  bearing- 
down  pain,  as  in  dysentery. 

Diarrhea  may  last  from  a  few  hours  to  as  many  days,  or  longer. 
It  may  become  chronic. 

Treatment. — In  all  cases,  rest  and  light  diet.  In  the  milder  forms 
nothing  further  may  be  required.  In  the  more  severe  forms  it  is 
a  good  plan  to  begin  with  a  dose  of  1  or  2  tablespoonfuls  of  castor  oil, 
to  which  10  or  12  drops  of  laudanum  may  be  added,  or  in  place  of  the 
oil  and  laudanum  Epsom  salts  may  be  given.  The  diet  should  be 
limited  to  light  articles,  such  as  cornstarch,  gruel,  weak  broths,  soft- 
boiled  eggs,  milk,  and  thoroughly  toasted  bread.  As  a  rule,  in  very 
acute  cases,  the  less  food  and  drink  taken  the  better.  The  patient 
should  rest  in  bed  and  keep  his  body  warm. 

After  the  bowels  have  been  freely  moved  by  the  oil  or  salts,  if  the 
diarrhea  or  pain  continue,  give  1  camphor  and  opium  pill,  and,  if 
necessary,  repeat  the  dose  after  an  interval  of  three  or  four  hours. 
If  nausea  and  vomiting  occur,  apply  mustard  to  the  region  of  the 
stomach,  and  give  tablespoonful  doses  of  equal  parts  of  milk  and 
limewater. 

In  chronic  diarrhea  careful  attention  to  diet  is  of  the  greatest  im- 
portance. The  treatment  is  about  the  same  as  for  chronic  dysentery. 

CHOLERA  MORBUS  (SPORADIC  CHOLERA). 

Cholera  morbus  is  an  affection  of  the  stomach  and  intestines, 
attended  by  vomiting,  purging,  and  cramps.  It  comes  on  suddenly, 
and  may  begin  by  vomiting  or  purging.  It  is  usually  met  with  dur- 
ing the  hot  months  of  summer.  It  is  frequently  caused  by  eating 
unripe  and  indigestible  fruits  and  vegetables,  decomposed  or  im-. 
properly  cooked  fish,  shellfish,  or  salad  mixtures.  Drinking  large 
quantities  of  iced  water  and  sudden  checking  of  the  perspiration,  or 
irritants  of  any  kind,  may  set  up  the  trouble.  The  disease  usually 
begins  suddenly,  often  at  night,  with  vomiting,  after  a  feeling  of 
uneasiness,  nausea,  or  a  severe  cramp.  The  contents  of  the  stomach 
are  first  thrown  up,  then  a  bilious  matter.  The  stools  are  at  first 
solid  or  semisolid,  but  they  soon  become  more  watery,  lose  their  color, 
and  sometimes  appear  not  unlike  the  rice-water  stools  of  genuine 
Asiatic  cholera.  The  patient  soon  has  a  wasted  look.  His  thirst 
is  unquenchable.  His  skin  may  become  cold  and  clammy  and  the 


22  MEDICAL.  HANDBOOK. 

pulse  very  weak.  Cramps  may  occur  in  the  feet  and  in  the  calves 
of  the  legs.  The  disease  runs  a  rapid  course.  The  acute  symptoms 
may  subside  in  a  few  hours.  The  attack  seldom  lasts  more  than 
twelve  hours.  Recovery  is  the  rule,  but  treatment  should  be  promptly 
applied. 

Treatment. — Apply  a  large  mustard  plaster  to  the  abdomen.  Give 
15  drops  of  laudanum.  If  the  dose  is  rejected  (immediately  vomited ) , 
try  it  again.  If  it  is  still  not  retained,  then  try  2  tablets  of  "  Sun 
Cholera  Mixture."  If  vomiting  quickly  occur,  then  inject  into  the 
rectum  by  means  of  a  glass  or  rubber  syringe  about  20  drops  of 
laudanum  mixed  with  a  little  thin  starch  or  a  little  water.  The 
rectal  injection  should  be  given  immediately  after  an  evacuation,  and 
the  patient  should  be  instructed  to  hold  it  as  long  as  possible.  In 
whatever  way  the  remedy  is  given  the  dose  should  be  repeated  in 
about  one  hour  if  the  vomiting  and  purging  continue. 

It  must  not  be  forgotten,  however,  that  all  these  remedies  contain 
opium,  and  that  if  the  patient  is  inclined  to  sleep  or  shows  other  con- 
stitutional effect  of  the  drug  the  dose  must  not  be  repeated. 

The  nausea  and  thirst  may  be  controlled  by  cracked  ice  placed  in 
the  mouth.  Small  quantities  of  carbonated  water  may  be  allowed. 
If  the  thirst  is  very  urgent,  a  tablespoonful  of  iced  water  may  be 
given  at  short  intervals. 

COLIC. 

Intestinal  or  spasmodic  colic. — These  terms  are  applied  to  abdom- 
inal pain  occurring  in  paroxysms  of  different  degrees  of  severity. 
The  pain  is  usually  referred  to  the  region  of  the  navel  or  middle 
of  the  belly.  It  may  be  due  to  indigestible  food,  cold  or  acid  drinks, 
poisons,  gases,  or  any  irritating  substance.  It  is  often  preceded  by 
obstinate  constipation.  Vomiting  frequently  occurs. 

Another  variety  of  colic,  called  lead  colic  or  painter's  colic,  is 
caused  by  lead  poisoning.  It  is  not  uncommon  in  painters  or  work- 
ers in  lead.  It  may  be  caused  by  drinking  water  taken  from  leaden 
pipes.  An  attack  may  be  mild  or  exceedingly  severe.  It  is  usually 
attended  by  obstinate  constipation  and  by  contraction  of  the  abdo- 
men. 

The  severe,  paroxysmal  pain  attending  the  passage  of  a  gallstone 
from  the  gall  bladder  to  the  intestine  is  called  biliary  colic.  In 
biliary  colic  the  pain  is  usually  most  marked  in  the  region  above  the 
navel  or  about  the  stomach  (epigastric  region).  The  paroxysms 
begin  and  end  suddenly.  Severe  nausea  and  vomiting  occur.  The 
skin  and  eyes  may  become  yellow  or  of  a  yellowish  hue  (jaundiced), 
the  same  as  in  bilious  colic.  Gallstones  may  occasionally  be  found 
in  the  stools  if  carefully  looked  for.  Some  cases,  however,  are 
difficult  to  distinguish  from  ordinary  intestinal  colic. 


DISEASES.  23 

The  severe,  excruciating  pain  caused  by  the  passage  of  a  small 
rough  stone  or  calculus  or  particles  of  sandy  substance  from  the 
kidney  through  the  ureter  to  the  urinary  bladder  is  called  nephritic 
colic,  kidney  colic,  or  an  attack  of  "  the  gravel."  The  pain  usually 
begins  with  a  one-sided,  boring  backache.  Suddenly  it  increases  in 
intensity  and  shoots  down  the  loin  to  the  hip  and  thigh,  and  the 
patient  writhes  in  agony  until  the  "stone"  or  particle,  sometimes 
not  larger  than  the  head  of  a  medium-sized  pin,  reaches  the  bladder, 
when  the  pain  suddenly  ceases.  The  paroxysm  may  last  from  half 
an  hour  to  a  number  of  hours,  or  one  or  two  days.  It  may  not  recur 
for  months  or  years;  on  the  other  hand,  there  may  be  two  or  more 
paroxysms  at  comparatively  short  intervals. 

Colicky  pains  are  present  in  many  different  diseases.  Appendicitis 
frequently  begins  with  pain  not  unlike  that  of  intestinal  colic. 

Treatment. — If  the  colic  is  due  to  indigestible  food,  or  too  much 
food  of  any  kind,  an  emetic  should  be  given,  such  as  mustard  and 
water. 

After  the  stomach  is  emptied  give  a  teaspoonful  of  aromatic  spirits 
of  ammonia  in  water.  Apply  a  large  mustard  plaster  or  a  hot  poul- 
tice or  cloths  wrung  out  of  hot  water,  or  .heat  o'f  any  kind  to  the 
abdomen.  (Local  applications  of  hot  water  usually  afford  some  relief 
in  any  variety  of  colic  or  wherever  pain  exists.)  If  the  colicky  pains 
persist,  10  or  12  drops  of  laudanum  should  be  given  by  the  mouth, 
and  repeated,  if  necessary,  in  two  hours;  or  30  or  40  drops  of  lauda- 
num in  a  little  water  or  starch  may  be  injected  into  the  rectum. 

If  the  bowels  were  constipated  when  the  attack  began,  an  injection 
of  soap  and  warm  water  should  be  given  by  the  rectum,  or  small  doses 
of  Epsom  salts  or  castor  oil  may  be  given  by  the  mouth.  The  diet 
for  a  day  or  two  should  be  light  articles  in  small  quantities  at  a  time. 
The  treatment  for  lead  colic  is  about  the  same,  except  that  the  consti- 
pation should  be  relieved  at  once  by  full  doses  of  Epsom  salts  or  castor 
oil.  Apply  heat  to  the  abdomen  or  place  the  patient  in  a  warm  bath. 
Pressure  applied  to  the  abdomen  affords  some  relief.  Remove  the 
cause  or  remove  the  patient  from  the  cause  of  the  disease. 

In  biliary  colic,  the  bowels  should  be  freely  moved,  patient  should 
be  placed  in  a  hot  bath,  and  laudanum,  30  drops,  given  to  relieve  pain. 

In  nephritic  or  kidney  colic,  hot  baths  and  laudanum,  30  drops, 
are  the  remedies. 

SCURVY. 

Scurvy  is  a  disease  produced  by  improper  or  unsuitable  food. 
Many  years  ago  it  was  of  frequent  occurrence  among  seafaring  men 
on  long  voyages.  Now  it  is  a  comparatively  rare  disease,  thanks  to 
better  provisions  and  better  methods  in  issuing  food  supplies. 

Symptoms. — Swelling,  sponginess,  and  bleeding  of  the  gums.  The 
teeth  become  loose  and  frequently  drop  out.  The  breath  is  foul,  the 


24  MEDICAL.  HANDBOOK. 

tongue  swollen.  The  skin  becomes  dry  and  scaly.  Hemorrhages 
(small  dark  red  spots')  occur  under  the  skin,  first  on  the  legs  and  then 
on  the  arms  and  other  parts  of  the  body.  Bleeding  from  the  nose 
frequently  occurs.  Swelling  about  the  ankles  is  common.  The  skin 
of  the  legs  is  frequently  discolored  in  large  blotches,  and  there  is  often 
a  peculiar  hardness  or  induration  of  the  muscles  of  the  calf  of  the 
leg.  The  complexion  is  frequently  of  greenish  or  dirty-yellow  hue. 
The  pulse  is  rapid  and  weak.  There  may  or  may  not  be  slight  fever. 
The  bowels  may  be  constipated  or  there  may  be  a  troublesome 
diarrhea. 

In  severe  cases  debility  and  emaciation  are  quite  marked.  The 
mind  wanders,  and  occasionally  there  is  wild  delirium. 

Treatment. — This  consists  almost  wholly  in  a  change  of  diet.  Give 
fresh  vegetables,  fresh  milk,  fresh  beef,  oranges,  lemons,  limes,  or 
lime  juice.  Begin  with  small  quantities  at  short  intervals,  and 
increase  the  allowance  as  rapidly  as  the  stomach  can  take  care  of  it. 
Pickles,  onions,  sauerkraut,  raw  potatoes,  and  raw  cabbage  are  valu- 
able articles  in  the  make-up  of  a  varied  diet. 

Potassium  chlorate  dissolved  in  water  should  be  used  as  a  mouth 
wash,  and  the  gums  should  be  frequently  painted  with  tincture  of 
myrrh.  The  skin  should  be  kept  in  good  condition  by  frequent  bath- 
ing. The  sleeping  quarters  should  be  clean  and  well  ventilated. 

SORE  THROAT   (TONSILLITIS,   QUINSY). 

Sore  throat  is  a  common  disease.  It  is  usually  the  result  of  expo- 
sure to  wet  and  cold.  Talking,  laughing,  or  shouting  in  a  damp, 
cold  atmosphere  is  sometimes  the  cause  of  it.  It  frequently  occurs 
in  persons  predisposed  to  rheumatism.  It  may  accompany  or  be 
an  extension  from  an  ordinary  "  cold  in  the  head."  Sometimes 
the  inflammation  is  limited  to  the  mucous  membrane  of  the  pharynx 
and  soft  palate;  it  is  then  known  as  pharyngitis  or  acute  catarrhal 
sore  throat.  More  frequently  the  tonsils  are  affected,  and  the  inflam- 
mation is  then  called  tonsillitis.  When  the  inflammation  is  more 
deeply  seated  in  the  tonsil  and  tends  to  suppurate  or  form  an 
abscess  the  term  quinsy  is  applied.  An  attack  of  sore  throat  may 
last  from  two  to  ten  days,  or  longer. 

Symptoms  of  acute  sore  throat  are  chilliness  and  feverishness, 
pain  or  soreness  on  swallowing,  dryness,  or  a  tickling  or  scratching 
sensation  in  the  throat. 

There  is  apt  to  be  a  stiffness  and  some  tenderness  along  the  side  of 
the  neck.  If  one  or  both  tonsils  are  involved,  as  they  usually  are 
to  a  greater  or  less  extent,  the  symptoms  are  more  severe.  In  marked 
cases  examination  shows  redness  and  swelling  of  the  parts  affected- 
swollen  tonsils  (tonsillitis)  and  white  or  cream-colored  spots  may  be 
seen  on  the  surface  of  one  or  both  tonsils.  (This  form  of  the  disease 


DISEASES.  25 

is  frequently  mistaken  for  diphtheria.)  There  may  be  high  fever 
and  great  prostration. 

In  the  severest  form  of  tonsillitis  (quinsy)  the  tonsil  is  hard  and 
swollen  to  twice  or  three  times  its  natural  size,  and  the  patient 
is  unable  to  swallow  or  to  open  his  mouth  beyond  a  fraction  of  an 
inch.  The  saliva  dribbles  away;  if  suppuration  occur  the  tonsil 
gradually  softens  until  the  abscess  breaks.  With  the  discharge  of 
the  pus  the  severe  pain  is  relieved  and  the  patient  rapidly  recovers. 
If  the  abscess  is  large,  and  if  the  pus  is  discharged  in  a  backward 
direction,  there  is  danger  from  suffocation,  particularly  if  the  abscess 
breaks  during  sleep.  Fortunately  the  abscess  usually  points  toward 
the  mouth,  and  the  pus  runs  out. 

Treatment. — Persons  who  are  subject  to  attacks  of  sore  throat 
should  keep  their  feet  dry  and  be  very  careful  not  to  catch  cold. 
If  a  case  develop,  give  a  gargle  of  salt  water  or  potassium  chlorate 
and  water  (saturated  solution),  or  boric  acid  and  water  may  be 
applied  to  the  tonsil.  Dry  bicarbonate  of  soda  (baking  soda)  is 
highly  recommended  as  a  local  application,  a  small  quantity  to  be 
applied  every  hour.  Apply  cold  water  or  a  light  ice  bag  to  the 
neck,  or  a  thick  piece  of  flannel  saturated  with  'ice  water  may  be 
placed  around  the  neck  and  covered  with  muslin.  Small  pieces  of 
ice  placed  in  the  mouth  are  usually  agreeable.  The  bowels  should 
be  kept  open  by  means  of  Epsom  salts. 

If  the  cold  applications  to  the  neck  do  not  give  relief,  or  if  they 
are  not  agreeable  to  the  patient,  apply  hot  water  or  poultices  and 
give  hot  gargles,  or  let  the  patient  gargle  with  hot  tea.  If  the  swell- 
ing is  very  great,  he  can  not  gargle.  If  practicable,  send  for  a 
physician. 

COUGHS  AND  COLDS. 

When  a  person  has  a  cough  that  lasts  more  than  two  or  three 
weeks,  even  though  the  symptoms  are  very  mild,  the  case  is  serious 
enough  to  require  an  examination  by  a  physician,  and  one  should  be 
consulted  on  the  first  opportunity. 

A  case  of  bronchitis  or  bad  cold  usually  begins  with  a  cough, 
sometimes  starting  with  an  irritation  in  the  throat,  which  gradually 
travels  down  into  the  lungs.  Though  the  cough  at  first  is  dry,  there 
will  be  some  expectoration  later  on,  especially  marked  in  the  morn- 
ing on  first  arising.  It  may  be  at  first  white  and  tenacious,  later 
on  becoming  yellowish.  With  this  there  will  be  some  soreness  over 
the  upper  and  front  part  of  the  chest,  and  if  the  cough  is  violent 
there  will  be  considerable  soreness  of  the  muscles  between  the  ribs. 

Treatment. — For  the  soreness  over  the  chest,  a  good  rubbing  with 
soap  liniment  may  help  to  relieve  the  symptom.  A  tablet  of  brown 
mixture  given  three  or  four  times  a  day  is  serviceable,  but  not  more 


26  MEDICAL.  HANDBOOK. 

than  4  should  be  given  during  the  24  hours.     The  bowels  should  be 
kept  open  by  a  tablespoonful  of  Epsom  salts,  when  necessary. 

Patients  with  coughs  and  colds  should  not  be  kept  in  a  hot,  dry 
room  without  ventilation.  Plenty  of  fresh  air  should  be  allowed  to 
come  into  the  room,  with  the  precaution,  however,  that  the  patient 
be  not  exposed  to  a  draft  and  that  he  be  properly  clothed  so  as  not 
to  become  chilled  when  the  weather  is  cold. 

ERYSIPELAS  (ST.  ANTHONY'S  FIRE). 

Erysipelas  is  an  inflammation  of  the  skin.  It  usually  begins  with 
a  chill,  followed  by  a  high  fever.  It  is  a  frequent  complication  of 
wounds,  but  is  more  frequently  developed  without  any  apparent 
injury.  A  large  majority  of  cases  begin  on  the  face,  usually  on  the 
nose,  first  as  a  small  red  spot,  which  is  soon  elevated  above  the  sur- 
rounding skin,  and  gradually  or  rapidly  spreads  over  the  face  and 
ears,  and  not  infrequently  over  the  entire  hairy  scalp ;  sometimes  over 
the  neck  and  chest,  and  occasionally  down  the  back  and  to  other 
parts  of  the  body.  The  skin  is  painful,  red,  hot,  and  swollen,  and 
blisters  frequently  form.  The  swelling  may  be  most  marked  about 
the  eyes  and  ears,  the  eyes  closed,  and  the  patient's  features  changed 
and  distorted  to  sucih  a  degree  that  the  appearance  once  seen  will 
not  soon  be  forgotten.  The  disease  limited  to  the  face  and  scalp 
usually  runs  its  course  in  a  few  days  or  a  week,  but  sometimes  before 
the  face  is  healed  red  spots  appear  on  other  parts  of  the  body,  and 
the  case  may  be  prolonged.  Abscesses  beneath  the  skin  are  not 
uncommon. 

Besides  the  symptoms  already  mentioned  there  are  headache,  loss 
of  appetite,  coated  tongue,  frequently  vomiting,  and  in  some  cases 
delirium  and  marked  depression. 

The  outcome  is  usually  favorable,  but  in  drunkards  or  in  persons 
debilitated  from  previous  diseases  death  is  sometimes  the  result. 

Treatment. — Erysipelas  is  only  slightly  contagious  under  ordinary 
circumstances;  but  persons  suffering  from  wounds  or  scratches  of 
the  skin  are  very  apt  to  be  attacked.  The  patient  should  therefore  be 
isolated — placed  in  a  room  by  himself — and  his  attendant  should  be  a 
healthy  man  and  free  from  any  skin  injury. 

Erysipelas  being  a  self-limited  disease,  it  is  a  common  saying 
among  physicians  that  the  majority  of  ordinary  or  moderately  severe 
cases  would  get  well  without  any  treatment.  But  this  is  probably 
true  of  many  other  diseases,  and  while  it  may  be  difficult,  perhaps 
impossible,  to  limit  the  spread  of  the  eruption  or  shorten  the  course 
of  the  disease  in  a  given  case  of  erysipelas,  something  may  be  done  to 
relieve  distressing  symptoms  and,  particularly  in  feeble  persons,  to 
fortify  the  system  against  the  attack.  "  Treat  the  patient  rather 
than  the  disease  "  is  good  advice  in  more  troubles  than  one. 


DISEASES.  27 

The  oldest  and  one  of  the  best  local  applications  for  erysipelas  is 
cold  water,  and  if  the  fever  is  very  high  cold  sponging  of  the  entire 
body  or  a  cold  bath  may  afford  considerable  relief.  Bismuth  sub- 
nitrate  may  be  dusted  over,  or  petrolatum  may  be  applied  to  the  skin. 
In  feeble  persons  stimulants  may  be  required. 

POISON  IVY. 

Contact  of  the  skin  with  the  poison  ivy  causes  in  many  people  a 
very  annoying  inflammation  of  the  skin.  The  vine  is  of  the  climbing 
variety,  with  three  pointed  leaves  on  each  stem.  A  few  hours  or  about 
a  day  after  the  skin  is  exposed  to  the  poison  of  this  plant  a  red  rash 
appears,  with  more  or  less  swelling  and  itching;  small  blisters  appear, 
filled  with  serum,  even  becoming  quite  large.  When  they  burst,  there 
is  considerable  weeping  from  the  surface.  Later  it  may  go  on  to  a 
formation  of  pus.  The  hands  and  face,  being  the  most  exposed  parts 
of  the  body,  and  the  feet  and  ankles  of  those  who  go  barefooted,  are 
usually  first  affected.  If  the  inflammation  is  very  severe,  there  may 
be  some  incidental  disturbance,  such  as  fever,  headache,  and  general 
feeling  of  malaise. 

Treatment. — One  of  the  best  treatments  for  this  disease  is  bathing 
with  salt  water,  sea  water  being  the  best.  Weak  alkaline  solutions, 
such  as  boric  acid,  about  2  grains  to  the  ounce,  are  good  applications. 
The  large  blisters  should  be  punctured  and  the  contents  allowed  to 
run  out.  Every  one  or  two  days  the  affected  parts  should  be  bathed 
with  warm  water,  carefully  dried  without  rubbing,  and  the  alkaline 
treatment  resumed. 

RHEUMATISM. 

There  are  different  forms  of  rheumatism  and  some  of  the  forms 
have  several  different  names.  Acute  rheumatism,  acute  articular 
rheumatism,  inflammatory  rheumatism,  and  rheumatic  fever  are 
terms  applied  to  one  and  the  same  disease.  A  milder  form  of  the 
affection  is  called  subacute  rheumatism.  In  this  form  the  symptoms 
are  less  severe,  but  the  disease  is  more  prolonged.  It  may  continue 
for  a  long  time  and  become  chronic.  Chronic  rheumatism,  however, 
or  the  different  affections  and  deformities  of  joints  to  which  this 
term  is  frequently  applied,  may  develop  independently  of  any  acute 
or  subacute  attack. 

The  term  muscular  rheumatism  indicates  an  affection  of  the  mus- 
cles as  distinguished  from  joint  affections.  Lumbago  and  stiff  neck 
are  varieties  of  muscular  rheumatism.  The  muscles,  however,  to 
a  greater  or  less  extent  may  be  involved  in  any  form  of  rheumatism. 

Other  conditions  simulating  rheumatism,  occuring  in  connection 
with  or  directly  due  to  gonorrhea  or  to  syphilis,  are  called  gonor- 
rheal  rheumatism  or  syphilitic  rheumatism,  as  the  case  may  be. 


28  MEDICAL  HANDBOOK. 

Acute  rheumatism  (rheumatic  fever)  is  a  comparatively  common 
disease  in  all  climates  within  the  Temperate  Zone.  It  occurs  chiefly 
during  the  winter  and  spring.  Exposure  to  a  cold,  damp  atmosphere 
is  the  most  frequent  exciting  cause  in  persons  predisposed  to  the 
disease. 

It  may  or  may  not  begin  with  a  chill  or  with  a  sore  throat.  The 
larger  joints  are  usually  affected.  Swelling,  heat,  redness,  tender- 
ness, and  pain  are  the  chief  symptoms.  The  inflammation  is  apt  to 
shift  from  one  joint  to  another.  The  pain  and  fever  are  usually 
increased  in  proportion  to  the  number  of  joints  involved.  The  ma- 
jority of  cases  are  attended  with  profuse  perspirations,  scanty,  highly 
acid  urine,  coated  tongue,  and  constipation.  The  heart  is  frequently 
involved. 

Treatment. — Wrap  the  joint  in  cotton  or  flannel;  keep  it  very 
quiet — the  slightest  movement  aggravates  the  pain.  Flannel  wrung 
out  of  hot  water  and  applied  to  the  joint  sometimes  affords  relief. 
Soap  liniment  may  be  applied  if  the  pain  is  severe,  or  cold  applica- 
tions may  be  applied  if  agreeable  to  the  patient. 

Place  the  patient  in  a  good  bed,  and  let  him  wear  flannel  next  to 
his  skin.  Change  the  flannel  frequently,  and  bathe  the  body  with 
tepid  water. 

For  internal  medication  give  salicylate  of  soda  in  doses  of  10  to 
15  grains  (0.6  gin.  to  1  gm.)  every  two  hours  until  about  eight  doses 
are  taken  or  the  pain  is  relieved,  then  give  it  in  smaller  doses  of 
from  3  to  5  grains  (0.2  gm.  to  0.3  gm.)  every  six  hours. 

The  food  should  be  soft  and  nourishing  and  given  every  three 
hours.  Epsom  salts  should  be  given  to  keep  the  bowels  open.  The 
patient  should  be  kept  in  bed  for  a  few  days  after  the  symptoms 
have  subsided.  The  duration  of  the  disease  is  very  uncertain.  The 
acute  symptoms  may  subside  in  a  few  days  and  the  patient  may  be 
up  and  about  in  a  week  or  ten  days,  but  relapses  are  common  and  the 
acute  may  pass  into  the  subacute  or  chronic  form. 

In  chronic  rheumatism  there  is  stiffness  and  pain.  A  cracking  or 
grating  sound  is  frequently  produced  when  the  joints  are  suddenly 
moved.  In  severe  cases  the  joints  become  enlarged  and  distorted. 
The  deformity  is  sometimes  very  great. 

The  treatment  consists  chiefly  in  local  application  of  liniments, 
etc.,  which  afford  relief  because  of  the  rubbing  (massage)  by  which 
they  are  applied.  Severe  pain  in  the  joint  may  be  relieved  by  cold 
applications  (flannel  wrung  out  of  iced  water,  applied  to  the  joint 
and  covered  with  muslin).  Hot  applications  to  the  joints  are  some- 
times of  value.  Belladonna  plaster  may  be  applied. 

Five  to  eight  grains  (0.3  gm.  to  0.5  gm.)  of  potassium  iodide  in  a 
glass  of  water  may  be  given  three  times  a  day  between  meals. 


DISEASES.  29 

The  general  health  should-  be  looked  after.  The  skin  should  be 
kept  in  good  condition  by  frequent  baths  of  tepid  water.  The 
bowels  should  be  moved  at  least  once  a  day.  Patient  should  be 
allowed  good  food.  Fresh  air  is  also  important. 

In  muscular  rheumatism  the  muscles  most  frequently  affected 
are  those  of  the  back  (lumbago),  side  of  neck  (stiff  neck  or  wry 
neck),  and  side  of  chest  (pleurodynia).  Exposure  to  cold,  sudden 
cooling  of  the  body — especially  after  active  exercise,  and  sitting  in 
a  draft  of  air — are  the  chief  causes,  or  exciting  causes. 

As  a  rule  there  are  no  symptoms  other  than  the  stiffness  and  pain 
on  motion.  The  muscles  may  be  slightly  swollen,  and  very  sensi- 
tive. Sometimes  the  attacks  come  on  suddenly  and  apparently  with- 
out cause,  or  following  a  slight  twist  or  strain,  as  a  "  kink  in  the 
back,"  or  patient  may  wake  up  in  the  morning  with  a  stiff  neck. 

Treatment. — In  acute  cases  salicylate  of  soda  may  be  given  in  5  or 
10  grain  doses  (0.3  gm.  to  0.6  gm.)  every  three  hours  until  four  or 
six  doses  are  taken.  Apply  hot  applications,  dry  heat,  hot-water 
bag,  or  a  hot  poultice  locally,  or  the  heat  may  be  applied  by  a  flat- 
iron,  over  folds  of  flannel  or  a  piece  of  blanket,  and  the  rheumatism 
"ironed  out."  Later  apply  liniment  with  friction  (massage).  Keep 
the  affected  muscles  at  rest.  If  the  muscles  of  the  chest  are  affected, 
apply  strips  of  adhesive  plaster,  the  same  as  for  fractured  rib.  Acute 
attacks  are  of  short  duration,  but  relapses  are  not  uncommon,  and 
chronic  forms  are  frequently  met  with.  Good  food,  fresh  air,  and 
attention  to  the  general  health  are  especially  important  in  the  treat- 
ment of  chronic  muscular  rheumatism. 

Gonorrheal  rheumatism  (gonorrheal  inflammation  of  joints)  may 
occur  during  an  acute  attack  of  gonorrhea,  but  it  is  more  frequently 
associated  with  chronic  gonorrhea  or  gleet.  One  or  several  joints 
may  be  affected.  There  may  or  may  not  be  considerable  fever.  If 
only  one  joint  is  affected  it  is  apt  to  be  the  knee  or  the  ankle.  In 
chronic  cases  the  pain  is  sometimes  centered  in  the  heel.  The  attack 
may  begin  in  the  wrist,  elbow,  or  shoulder.  The  disease  is  not  always 
limited  to  the  joints.  Sometimes  the  inflammation  is  in  the  tissues 
outside  the  joint  proper,  in  the  sheaths  of  the  tendons  of  muscles, 
or  in  the  fascia  of  the  soles  of  the  feet.  The  swelling  is  frequently 
quite  marked.  In  chronic  cases  there  may  be  effusion  ("  water  on 
the  joint ") .  In  very  severe  cases  suppuration  occurs  (abscess  forms) . 
The  eye  and  the  heart  may  also  be  seriously  involved. 

Treatment  is  not  very  satisfactory.  Give  from  5  to  10  grains  (0.3 
gm.  to  0.6  gm.)  potassium  iodide  in  a  little  water  between  meals. 
Keep  the  joint  at  rest.  Apply  a  flannel  bandage.  Change  it  fre- 
quently and  wash  the  joint  with  hot  water  and  soap.  In  chronic 
cases  liniments  and  passive  motion  should  be  applied.  Tincture  of 
iodine  may  be  painted  over  the  joint. 


30  MEDICAL,  HANDBOOK. 

Syphilitic  rheumatism,  so  called,  is  associated  with  secondary  or 
tertiary  syphilis.  The  joints  and  the  shafts  of  long  bones  may  be 
affected — thickened  and  painful.  The  pain  is  always  worse  at  night. 

The  treatment  is  by  potassium  iodide,  beginning  with  10  grains 
(0.66  gm.)  of  potassium  iodide  three  times  a  day  between  meals. 
Good  food  and  attention  to  the  bowels  are  important. 

FAINTING. 

Treatment. — When  a  person  feels  faint,  or  actually  faints,  he 
should  be  laid  flat  upon  the  bed  or  the  floor,  with  the  head  at  least 
as  low  as  the  body,  and  the  clothing  around  the  neck  and  chest 
loosened.  A  teaspoonful  of  aromatic  spirits  of  ammonia  should  be 
given  in  a  third  of  a  glass  of  water.  He  should  remain  in  this  reclin- 
ing position  until  the  attack  has  passed  off. 

DELIRIUM  TREMENS. 

Delirium  tremens  occurs  as  an  incident  in  the  life  of  persons 
addicted  to  the  excessive  use  of  intoxicating  liquors. 

Loss  of  appetite,  sleeplessness,  or  a  marked  mental  depression  are 
the  chief  symptoms  of  the  first  stage  of  the  affection  which  is  known 
among  drunkards  as  "  the  horrors." 

As  the  disease  advances  the  patient  talks  incoherently ;  has  a  wild 
expression;  his  mind  wanders  from  one  thing  to  another.  He  an- 
swers questions  in  a  rambling  manner.  He  fancies  he  is  being  pur- 
sued by  wild  animals  or  that  he  sees  rats,  snakes,  and  the  other 
animals  crawling  on  the  walls  or  around  his  bed,  or  he  may  imagine 
himself  to  be  engaged  in  his  regular  duties  or  as  master  of  the  ship, 
giving  directions  to  the  men. 

The  delirium  is  always  worse  at  night,  but  the  patient  requires 
careful  watching  all  the  time.  He  may  try  to  jump  overboard  or 
commit  suicide. 

Delirium  tremens  may  be  confounded  with  acute  inflammation  of 
the  brain  or  with  acute  mania  (insanity)  or  with  certain  forms  of 
pneumonia,  and  any  one  of  these  diseases  may  also  be  present.  Pneu- 
monia is  a  frequent  complication  of  delirium  tremens,  and  in  fatal 
cases  may  be  the  direct  cause  of  death. 

In  favorable  cases  the  symptoms  begin  to  improve  in  three  or  four 
days  from  the  onset.  The  patient  sleeps  and  gradually  recovers. 

Treatment. — The  patient  requires  constant  attendance.  Physical 
restraint  should  be  avoided  if  possible.  To  support  the  patient  and 
to  procure  sleep  are  the  great  objects  of  treatment.  Careful  feeding 
is  very  important.  Milk  or  concentrated  broths  should  be  given  at 
regular  intervals  of  two  hours.  A  cold  bath  is  of  value  in  some 
cases,  especially  if  agreeable  to  the  patient.  In  other  cases  a  warm 
bath  or  a  hot  foot  bath  may  have  a  better  effect. 


DISEASES.  31 

The  serious  symptoms  are  largely,  if  not  entirely,  due  to  the  sleep- 
lessness, and  if  several  hours  of  sound  sleep  can  be  procured  improve- 
ment is  almost  sure  to  follow.  To  this  end  potassium  bromide  in 
30-grain  doses  may  be  given  in  water  every  three  hours.  Morphia 
or  opium  are  not  to  be  recommended  in  this  disease  except  under 
the  immediate  direction  of  a  physician. 

APPENDICITIS. 

Appendicitis  is  an  inflammation  involving  the  appendix  vermi- 
formis.  This  is  a  small  attachment  of  the  large  intestine  situated  in 
the  right  groin.  It  may  begin  suddenly  with  violent  pains  in  the 
right  groin,  some  fever,  collicky  pains,  nausea,  and  vomiting.  The 
seat  of  the  pain  is  usually  on  a  line  drawn  between  the  bony  promi- 
nence (the  large  bone  of  the  pelvis)  just  above  and  on  the  outer  side 
of  the  right  groin  and  the  umbilicus.  As  the  attack  progresses,  that 
region  of  the  abdomen  may  become  hard  like  a  board  and  exceed- 
ingly sensitive  to  the  touch.  Often  you  will  find  that  the  patient 
flexes  the  right  leg  on  the  abdomen,  and  the  effort  to  straighten  it  out 
causes  him  great  pain.  Sometimes  the  attack  is  much  milder  with 
only  an  uneasy  sensation  in  the  right  groin,  very  slight  fever,  if  any, 
-and  a  sense  of  tenderness  over  the  part  affected.  This  pain  may  be 
in  the  pit  of  the  stomach  or  about  the  umbilicus. 

After  this  pain  has  been  present  for  a  few  days  a  swelling  in  the 
right  groin  may  appear,  due  to  the  formation  of  pus  or  to  a  large 
protective  exudation  of  lymph. 

Treatment. — The  right  course  to  pursue  in  a  case  of  appendicitis 
is  to  call  in  a  surgeon.  If  the  services  of  a  surgeon  or  physician  can 
not  be  secured,  the  plan  of  treatment  should  be  as  follows:  Absolute 
rest  in  bed  with  an  ice  bag  over  the  appendix,  to  be  continued  during 
the  stage  of  severe  pain.  Do  not  give  purgatives.  Reduce  the  allow- 
ance of  food  and  drink  of  all  kinds  to  the  lowest  possible  limit.  If 
the  pain  is  very  severe,  20  drops  of  laudanum  in  a  littte  water  may  be 
given  to  control  it.  If  the  bowels  move,  a  bed  pan  should  be  used, 
and  under  no  circumstances  should  the  patient  be  allowed  to  get  up. 

SYPHILIS. 

Syphilis  is  a  constitutional  disease.  It  is  contagious,  or  commu- 
nicable, and  is  usually  acquired  during  sexual  contact.  It  may,  how- 
ever, be  contracted  in  many  different  ways,  direct  and  indirect.  It 
begins  by  a  primary  lesion  or  sore  called  a  chancre  at  the  seat  of  inoc- 
ulation (where  the  virus  enters),  and  is  followed  by  eruptions  of  the 
skin  of  different  forms  and  different  degrees  of  severity  and  variable 
duration.  Sores  also  appear  at  the  angle  of  the  mouth,  and  mucous 
patches  develop  on  the  lips,  tongue,  inner  sides  of  the  cheeks,  and 
sore  throat  is  very  common. 


32  MEDICAL  HANDBOOK. 

Mucous  patches  or  syphilitic  warts  are  also  frequently  seen  about 
the  anus  or  in  any  region  where  the  skin  is  moist.  The  hair  fre- 
quently falls  out,  the  eyes  are  sometimes  seriously  involved,  and  sooner 
or  later  every  organ  in  the  body  may  become  affected.  A  man  suffer- 
ing from  syphilis  in  active  form  should  not  be  allowed  to  go  on 
board  a  ship,  and  if  the  disease  breaks  out  while  on  the  voyage  he 
should  be  isloated,  or  at  least  be  compelled  to  use  separate  drinking 
cups,  knives,  spoons,  forks,  towels,  etc.  He  should  under  no  circum- 
stances smoke  the  pipe  belonging  to  another  man  nor  allow  another 
man  to  smoke  his.  All  his  belongings  should  be  kept  strictly  to 
himself,  for  unless  the  greatest  care  is  taken  other  men  of  the  crew 
will  suffer.  Chancre  of  the  lip  may  be  acquired  by  smoking  the  pipe 
of  a  syphilitic. 

The  primary  or  initial  lesion  of  syphilis  (the  hard  chancre)  usually 
appears  about  three  weeks  after  exposure,  but  may  be  as  early  as  ten 
or  twelve  days  or  as  late  as  five  or  six  weeks.  It  begins  as  a  red  spot 
or  papule,  which  usually  breaks  and  forms  a  small  ulcer  with  hard 
edges ;  sometimes  the  sore  appears  as  a  simple  excoriation  or  super- 
ficial ulcer  without  hard  edges.  The  neighboring  lymph  glands 
become,  in  the  course  of  a  week  or  two,  enlarged  and  hard.  They 
seldom  suppurate.  About  two  months  later  the  skin  eruption  and 
ether  secondarjr  symptoms  begin.  The  lymph  glands  above  the 
elbow,  along  the  side  and  back  of  neck,  and  all  over  the  body  are 
usually  enlarged.  Patient  frequently  complains  of  headache  and 
pain  in  the  limbs,  always  worse  at  night,  and  may  have  slight,  occa- 
sionally considerable,  fever. 

Treatment. — For  the  primary  sore  bathe  the  part  with  soap  and 
water  and  dust  boric  acid  over  it  twice  a  day. 

If  secondary  symptoms,  eruptions  of  skin,  etc.,  appear,  give  a  pill 
of  calomel,  one-fifth  grain,  three  times  a  day.  The  mouth  and 
teeth  should  be  kept  clean  by  means  of  a  soft  toothbrush  and  castile 
soap  and  water,  or  water  to  which  a  small  quantity  of  bicarbonate 
of  soda  (baking  soda)  or  tincture  of  myrrh  has  been  added.  If 
mucous  patches  appear  in  the  mouth,  smoking  must  not  be  allowed. 
If  on  board  ship,  as  soon  as  the  ship  arrives  in  port  send  'or  take  the 
man  to  the  marine-hospital  office  and  receive  the  advice  of  a  surgeon 
as  to  further  treatment. 

SOFT  CHANCRE  (CHANCROID). 

Soft  chancre  or  chancroid  is  a  virulent  ulcer.  It  usually  begins 
within  thirty-six  hours  after  exposure,  first  as  a  red  spot,  but  rapidly 
developing  into  an  ulcer  covered  with  thick  yellowish  pus.  The 
period  of  development  is  about  three  or  four  days.  Sometimes  a 
week  elapses  from  the  time  of  exposure  to  the  development  of  the 
sore,  and  occasionally  a  period  of  incubation  is  as  long  as  ten  days. 


DISEASES.  33 

A  sore  appearing  within  a  few  days  or  a  week  or  even  as  late  as  ten 
days  after  the  exposure  is  usually  regarded  as  a  chancroid;  but  in 
practice  this  is  not  a  safe  rule,  for  the  reason  that  many  venereal 
sores  are  of  a  mixed  character.  The  inoculations  of  both  poisons  may 
take  place  at  the  one  and  same  spot — the  result  is  a  mixed  chancre ;  or 
if  two  sores  appear,  the  orgin  of  one  may  be  syphilitic,  the  other 
chancroidal.  It  is  therefore  difficult,  if  not  impossible,  in  many 
cases  to  determine  the  character  of  the  disease  from  the  period  of 
incubation  or  from  the  appearance  or  local  characteristics  of  the 
sore.  A  mixed  chancre  is  a  syphilitic  chancre  (a  hard  chancre), 
while  its  appearance  may  be  precisely  like  that  of  the  soft  chancre  or 
chancroid.  The  only  safe  plan  is  to  regard  all  venereal  sores  as  sus- 
picious. But  while  this  is  true,  treatment  for  syphilis  should  not  be 
commenced  before  the  appearance  of  secondary  symptoms,  for  unless 
such  symptoms  appear  it  is  impossible  to  determine  that  syphilis 
really  exists  in  any  case.  The  mixed  chancre,  as  already  stated,  is 
essentially  a  syphilitic  chancre,  and  the  beginning  of  constitutional 
disease.  Its  local  effects,  however,  may  be  precisely  the  same  as  those 
of  soft  chancre  or  chancroid.  The  ulcer  (or  ulcers — sometimes  there 
are  two  or  more)  may  remain  as  small  as  a  pea  OP  grow  as  large  as 
a  quarter,  and  if  it  becomes  phagedenic  (eating)  may  spread  over  a 
large  surface  of  the  body.  It  is  also  proper  to  state  that  a  secondary 
syphilitic  sore  may  appear  under  the  foreskin,  as  well  as  at  any 
other  place  on  the  body,  and  that  cancer  (epithelioma)  of  the  organ 
may  begin  as  a  small  ulcer.  The  latter,  however,  is  a  rare  disease 
as  compared  with  the  different  varieties  of  chancre. 

The  most  frequent  complication  of  soft  chancre  or  chancroid  is 
inflammation  of  the  lymph  glands  of  the  groin  (bubo),  known  to 
the  sailor  as  "blue  balls."  Another  troublesome  and  serious  com- 
plication is  the  elongation  and  contraction  of  the  orifice  of  the  fore- 
skin (phimosis),  on  the  inner  surface  of  which  the  sores  may  be 
located,  and  the  swelling  and  tension  may  be  so  great  as  to  pro- 
duce gangrene  (mortification).  If  the  foreskin  is  very  tight  and 
pulled  back  and  can  not  be  brought  forward  again,  the  condition 
is  known  as  paraphimosis,  which  produces  great  swelling,  the  same 
as  if  a  string  were  tied  around  the  organ,  frequently  resulting  in 
severe  ulceration  and  destruction  of  tissue.  This  condition  may  also 
be  the  result  if  the  inflammation  and  swelling  are  marked  and  the 
foreskin  very  tight. 

The  sore  should  be  dried  and  covered  with  a  small  piece  of  aseptic 
gauze  or  absorbent  cotton,  and  later  a  dusting  powder  of  boric  acid 
may  be  applied. 

If  phimosis  exist,  the  cavity  of  the  foreskin  should  be  syringed 
out  with  hot  water,  and  if  there  are  sores  under  the  foreskin  which 
can  not  be  reached  by  the  acid  the  cavity  should  be  syringed  with 
21824°— 12 3 


34  MEDICAL  HANDBOOK. 

a  solution  of  one  part  of  carbolic  acid  to  forty  parts  of  water  (1  to 
40).  Soft  chancres  or  chancroids  appearing  at  the  anus  or  rectum 
should  be  treated  by  frequent  washings  of  warm  water  and  the  appli- 
cation of  calomel. 

In  all  cases,  wherever  the  sore  is  located,  cleanliness  must  be  insisted 
upon,  and,  as  already  stated,  in  nearly  all  inflammations  of  whatso- 
ever character,  hot  water  alone  is  a  valuable  remedy;  and  rest  in  bed 
is  of  equal  importance.  If  a  lump  (bubo)  appear  in  the  groin,  rest  in 
bed  is  of  the  greatest  importance.  The  diet'  should  be  light  but  nour- 
ishing. Tincture  of  iodine,  pure  or  diluted  one-half  with  alcohol, 
may  be  painted  over  the  lump,  but  it  is  not  of  much  value.  Rest  is 
the  important  thing.  If  the  bubo  go  on  to  suppuration,  it  should  be 
carefully  opened  with  the  point  of  a  knife,  and  kept  open  by  a  strand 
of  aseptic  gauze,  which  must  be  frequently  changed,  and  enough 
aseptic  gauze  should  be  placed  on  top  of  the  wound  to  absorb  the 
discharges.  The  soiled  gauze  should  be  burned,  and  the  person 
handling  it  must  be  careful  to  wash  his  hands  in  soap  and  water  and 
in  one  of  the  antiseptic  solutions  already  referred  to.  The  patient's 
bowels  should  be  moved  once  a  day. 

GONORRHEA  (CLAP). 

Gonorrhea  is  a  specific  inflammation  of  the  urethra  due  to  a  micro- 
organism, called  gonococcus.  It  usually  begins  during  the  first  week 
after  exposure,  sometimes  as  early  as  three  or  four  days,  and  occasion- 
ally as  late  as  ten  days  or  two  weeks.  The  first  symptoms  are  a 
tickling  or  itching  sensation  and  a  slight  swelling  about  the  lips  of 
the  orifice  of  the  urethra.  A  purulent  creamy  colored  discharge  soon 
appears,  and  a  burning  or  stinging  pain  attends  the  passage  of  urine. 
The  inflammation  gradually  extends  to  the  deeper  parts  of  the 
urethra,  and,  unless  checked  by  medication,  reaches  its  height  about 
the  end  of  the  second  or  during  the  third  week.  The  patient  may 
experience  great  difficulty  in  passing  water.  If  the  inflammation 
run  very  high,  abscesses  may  form  in  the  tissues  around  the  urethra, 
and  swelled  testicle  and  bubo  are  frequent  complications;  also  pain- 
ful erections  and  bending  of  the  organ  (chordee).  Phimosis  or  para- 
phimosis  occurs  if  the  foreskin  is  tight  or  becomes  involved  in  the 
inflammation. 

If  phimosis  occur,  and  if  the  cavity  of  the  foreskin  is  not  thor- 
oughly and  frequently  washed  out.  "  venereal  warts  "  are  apt  to  form. 

True  gonorrhea,  if  carefully  treated,  gradually  subsides  and  recov- 
ery may  take  place  in  from  four  weeks  to  two  months.  A  urethral 
discharge  that  recovers  in  a  few  days  or  a  week  is  probably  a  simple 
urethritis. 

Gonorrhea  is  urethritis  (inflammation  of  the  urethra),  but  ure- 
thritis is  not  necessarily  gonorrhea. 


DISEASES.  35 

Treatment. — Rest  in  bed,  light  diet,  plenty  of  water  to  drink, 
regularity  in  eating  and  sleeping.  Keep  the  bowels  open  by  taking 
a  moderate  dose  of  Epsom  salts  in  the  morning.  Avoid  strong  coffee 
and  tea,  all  stimulants,  and  greasy  articles  of  food.  Keep  the  body 
and  mind  at  rest.  Bathe  frequently  in  hot  water.  Be  very  careful 
not  to  carry  any  of  the  pus  from  the  urethra  to  the  eyes.  (Gonor- 
rheal  inflammation  of  the  eyes  is  a  very  serious  disease,  which  not 
infrequently  results  in  total  blindness  and  loss  of  the  eyes.) 

Give  a  copaiba  capsule  three  times  a  day.  If  much  pain  in  the 
back  or  over  the  region  of  the  kidneys  follow  the  use  of  the  copaiba, 
it  must  be  discontinued  for  a  time  or  the  dose  lessened. 

If  the  chordee  is  troublesome,  apply  cloths  wrung  out  of  cold 
water. 

A  snug  suspensory  bandage  worn  from  the  beginning  may  prevent 
the  complication  of  swelled  testicles.  If  the  patient  is  lying  in  bed, 
the  dragging  of  the  testicles  should  be  prevented  by  placing  them  on 
a  support.  The  best  local  remedy  for  swelled  testicles  is  heat,  which 
may  be  applied  by  pieces  of  cloth  or  flannel  wrung  out  of  hot  water. 

STRICTURE  OF  THE  URETHRA. 

True  or  organic  stricture  of  the  urethra  is  a  narrowing  of  the 
tube.  It  is  commonly  the  result  of  long-continued  or  neglected 
gonorrhea.  Stricture  of  the  urethra  may  be  produced  by  direct 
injuries,  as  kicks  or  falls  on  the  perineum,  or  by  the  use  of  too 
strong  injections,  or  by  the  careless  passage  of  instruments. 

Occasionally  stricture  results  from  simple  urethritis,  not  gonor- 
rheal,  and  symptoms  not  unlike  those  of  stricture  are  sometimes 
caused  by  a  stone  in  the  bladder  obstructing  the  passage,  and  by  an 
enlarged  prostate  gland. 

Gonorrheal  stricture  of  the  urethra  is  usually  of  slow  development. 
It  may  be  several  months  or  years  after  the  attack  of  gonorrhea 
before  the  patient  becomes  conscious  of  any  change  in  the  size  or 
shape  of  the  stream.  First  there  may  be  only  a  twisting  or  flattening 
of  the  stream.  In  severe  cases  it  gradually  becomes  smaller  and 
smaller,  until  it  is  no  larger  than  a  knitting  needle  and  passed  with 
great  difficulty,  or  it  comes  away  drop  by  drop,  and  finally  results 
in  complete  retention.  One  of  the  earliest  symptoms  of  stricture  is 
a  gleety  discharge  from  the  urethra. 

Occasionally  retention  of  urine  is  the  first  symptom  of  the  disease. 

Sudden  retention  may  be  due  to  spasm  of  the  urethra  (spasmodic 
stricture) . 

Spasmodic  stricture  may  occur  independently  of  any  specific  dis- 
ease of  the  urethra,  but  it  is  more  frequently  a  complication  of 
organic  stricture.  Exposure  to  cold  and  wet  (catching  cold),  or  a 
debauch,  are  the  usual  exciting  causes. 


36  MEDICAL,  HANDBOOK. 

When  retention  occurs  the  bladder  gradually  becomes  distended 
and  a  fullness  or  distinct  tumor  may  be  felt  in  the  lower  part  of  the 
abdomen,  which  in  severe  cases  may  extend  as  high  as  the  navel. 
Sometimes  there  is  an  involuntary  flow,  or  an  overflow  of  urine  from 
a  distended  bladder — patient  says  he  can  not  hold  his  water,  and  in 
such  case  it  may  be  difficult  to  convince  him  that  he  is  suffering  from 
retention,  until  a  catheter  is  passed  and  a  quantity  of  urine  is  with- 
drawn. 

Treatment. — A  neglected  stricture  of  the  urethra  is  a  serious  dis- 
ease, the  treatment  of  which  is  very  difficult  in  many  cases,  even  in 
the  hands  of  the  most  experienced  surgeon. 

If  a  case  is  allowed  to  run  on  until  there  is  an  actual  stoppage  or 
retention  of  urine,  unless  this  condition  is  relieved  the  consequences 
are  extremely  serious  and  death  may  be  the  result. 

Place  the  patient  on  his  back  with  his  knees  slightly  drawn  up, 
and  try  to  pass  a  catheter.  The  instrument  should  first  be  thoroughly 
cleansed  by  placing  it  in  boiling  water.  It  should  then  be  oiled  with 


PIG.  1. — How  to  use  catheter ;  shows  the  curve  of  the  channel  through  which  the  catheter 

must  pass. 

olive  oil,  and  carefully  passed  into  the  urethra  and  effort  made  with 
the  greatest  gentleness  to  pass  into  the  bladder.     (Fig.  1) 

Try  the  largest  size  catheter  (about  a  No.  10  English)  first;  if  this 
fail,  try  the  smaller  ones.  If  a  catheter  can  not  be  passed  at  the  first 
trial,  place  the  patient  in  a  hot  bath,  give  him  20  drops  of  laudanum, 
and  an  hour  or  two  later  try  the  catheter  again.  If  it  is  not  prac- 
ticable to  place  the  patient  in  a  full  bath  of  hot  water,  then  cover  his 
belly  and  other  parts  of  his  body  with  flannels  wrung  out  of  hot 
water  and  change  them  every  fifteen  minutes.  The  object  of  the  hot 
bath  and  the  laudanum  is  to  produce  relaxation.  Sometimes  a  pa- 
tient will  pass  his  water  in  the  bath.  If,  however,  the  symptoms  are 
very  urgent,  if  the  patient  can  not  pass  any  water,  and  after  the 
most  careful  and  gentle  manipulation  the  catheter  can  not  be  passed 
into  the  bladder,  the  services  of  a  surgeon  should  be  secured. 


DISEASES.  37 

BOILS. 

A  boil  is  a  circumscribed  inflammation  of  the  skin  and  connective 
tissue.  It  is  often  caused  by  infection  following  a  slight  wound  or 
scratch  of  the  skin,  but  may  occur  apparently  without  any  cause.  It 
begins  as  a  small  red  pimple  and  gradually  increases  in  size  and 
forms  a  dusky  red  swelling,  the  size -of  a  silver  dollar  or  less.  The 
central  portion  of  the  swelling  sloughs  or  forms  a  "core,"  and  as 
soon  as  the  core  is  separated  or  cast  off  the  inflammation  subsides,  the 
pain  lessens,  and  the  ulcer  begins  to  heal. 

Treatment. — Hot  applications,  frequently  renewed,  until  the  cen- 
tral portion  of  the  boil  is  softened.  Then  the  separation  of  the  core 
may  be  aided  by  an  incision.  The  incision  should  be  made  by  a  thin 
blade,  thoroughly  boiled  before  it  is  used.  After  the  core  is  dis- 
charged the  ulcer  should  be  dressed  with  aseptic  gauze,  held  in 
place  by  a  bandage. 

PILES. 

Piles  are  varicose  dilatations  of  the  veins  of  the  rectum.  The 
symptoms  may  be  slight  or  severe.  Inflamed  piles  are  very  painful. 
There  is  a  constant  burning  sensation  at  the  anus,  which  is  greatly 
increased  during  and  immediately  after  each  movement  of  the  bowels. 
When  the  veins  rupture  you  have  "bleeding  piles."  Occasionally 
the  inflammation  of  a  nodule  results  in  an  abscess. 

Treatment. — Piles  are  frequently  due  to  habitual  constipation,  and 
when  that  condition  is  improved  the  piles  often  disappear,  or  at  least 
cease  to  be  troublesome.  The  bowels  should  be  kept  in  good  condi- 
tion. One  easy  movement  should  take  place  regularly  every  day. 
This  desirable  habit  should  be  brought  about  by  careful  attention  to 
diet  and  by  drinking  water  in  the  morning  before  breakfast  rather 
than  by  the  use  of  cathartics. 

In  acute  attacks,  if  the  bowels  are  constipated  give  a  full  dose  of 
epsom  salts ;  put  the  patient  on  light,  soft  diet.  Apply  ice  to  the  anus 
or  inject  cold  water  into  the  rectum.  A  hot  application  is  some- 
times very  grateful.  If  the  piles  protrude,  especially  if  they  become 
strangulated,  they  should  be  pushed  back  with  the  finger;  olive  oil 
or  petrolatum  may  be  applied.  If  the  piles  are  large  and  persistently 
painful,  see  a  surgeon  and  have  them  removed  by  operation,  which 
is  the  only  sure  cure. 

INJURIES— HEMORRHAGE  (BLEEDING). 

In  all  cases  of  injury  careful  examination  should  be  made  of  the 
part,  after  carefully  washing  the  hands. 

Hemorrhage  is  of  three  kinds — arterial,  venous,  capillary. 
Arterial  (bright-red  blood  from  arteries  in  jets  or  spurts). 


38  MEDICAL,  HANDBOOK. 

Venous  (dark-red  or  purple  blood  welling  out  or  flowing  from 
veins  in  steady  stream). 

Capillary  (blood  oozing  from  the  capillaries  over  the  general  sur- 
face of  a  wound). 

If  the  bleeding  is  by  jets  or  spurts,  pressure  should  immediately 
be  made  above  the  wound  by  the  thumb  or  finger,  or  better  by  tying 
rubber  tubing  around  the  limb,  or,  in  the  absence  of  such  a  tube,  a 
bandage,  handkerchief,  suspender,  strap,  or  soft  rope  may  be  used  to 
stop  or  lessen  the  flow  of  blood ;  the  blood  vessel  should  then  be  seized 
and  drawn  gently  forward  with  a  pair  of  artery  forceps  and  the 
ends  tied  with  silk  ligature  in  a  reef  knot,  when  the  tubing  or  strap 
should  be  loosened  or  removed. 

If  the  blood  vessel  is  torn  but  not  completely  divided,  tie  a  silk 
ligature  around  the  vessel  on  each  side  of  the  wound. 

Straps  or  bandages  applied  to  control  or  lessen  the  danger  of 
hemorrhage  must  always  be  placed  above  the  wound — that  is  to  say, 
between  the  bleeding  point  and  the  heart.  In  wounds  of  the  foot, 
for  example,  if  the  arteries  spurt,  pressure  should  be  made  in  the 
hollow  back  of  the  knee.  If  the  blood  is  flowing  slowly  or  oozing 
and  does  not  come  by  jets  or  spurts,  aseptic  gauze  or  lint  wrung  out 
of  hot  water  should  be  applied  and  firmly  bandaged  over  the  wound, 
or  hot  water  may  be  poured  over  the  wound  before  applying  the 
aseptic  gauze  or  lint.  In  any  case  it  is  well  to  cleanse  the  wound 
with  hot  water.  The  oozing  may  also  be  stopped  by  exposing  the 
wound  to  fresh  air  and  by  allowing  a  stream  of  cold  water  to  fall 
upon  it,  and  then  applying  pressure. 

Before  beginning  the  treatment  of  any  wound  or  any  bleeding 
point,  the  operator  must  carefully  cleanse  his  hands  and  arms,  also 
the  wound  and  surrounding  parts,  and  the  instruments  and  silk  liga- 
ture should  be  boiled,  as  will  be  described  under  the  head  of  wounds. 

In  the  after  treatment  of  severe  bleeding  the  patient  should  be  kept 
perfectly  quiet  in  mind  and  body,  his  head  should  be  lowered  by 
raising  the  foot  end  of  his  bed  or  bunk.  Give  him  plenty  of  fresh 
air,  but  keep  his  body  warm  and  give  him  hot  drinks.  After  reaction 
the  temperature  of  the  body  may  rise  a  degree  or  two  above  normal, 
but  if  this  should  continue  longer  than  two  or,  at  most,  three  days, 
the  dressing  should  be  removed  and  the  wound  thoroughly  irrigated, 
first  with  hot  water,  then  with  a  solution  of  bichloride  of  mercury 
(1  to  5,000),  and  dressed  with  aseptic  gauze. 

WOUNDS. 

Incised  wounds  inflicted  by  sharp  cutting  instruments  may,  after 
the  bleeding  has  been  stopped,  be  drawn  together  with  the  fingers 
or  with  a  needle  and  silk  ligature,  a  thin  layer  of  absorbent  cotton 
applied  over  the  wound  and  held  with  adhesive  plaster.  Strips  of 


INJURIES.  39 

adhesive  plaster  may  be  used  over  the  dressing.  The  parts  should  be 
thoroughly  cleansed,  first  by  scrubbing  with  hot  water  and  soap — the 
skin  to  be  shaved  if  hairy — then  washed  with  grain  alcohol  (not  wood 
alcohol)  and  then  again  with  hot  water  before  the  edges  are  drawn 
together.  The  needle  and  silk  ligature  and  all  instruments  should 
be  boiled  before  they  are  used.  The  operator  must  roll  up  his  sleeves, 
scrub  his  hands  and  arms  with  hot  water  and  soap,  clean  and  trim 
his  finger  nails,  scrub  again  with  soap  and  water,  then  with  grain 
alcohol  (not  wood  alcohol),  and  finally  soak  his  hands  in  a  solution 
of  bichloride  of  mercury  (1  to  1,000)  before  beginning  the  operation. 
The  wound,  if  deep,  should  not  be  completely  closed ;  one  end  should 
be  left  open  for  drainage  unless  the  patient  is  under  the  direct  care 
and  treatment  of  a  surgeon. 

Contused  and  lacerated  wounds  with  torn  and  ragged  edges,  espe- 
cially if  the  surrounding  parts  are  bruised  or  crushed,  should  not  be 
drawn  tightly  together.  The  bleeding  from  lacerated  wounds  at  the 
time  of  the  accident  is  not  so  profuse  as  in  incised  wounds,  but  the 
shock  is  greater,  and  very  troublesome  and  serious  hemorrhage  may 
come  on  within  a  few  hours  or  later.  To  guard  against  this  the 
wound  should  be  carefully  examined  (the  operator's  hands  and  all 
instruments  to  be  first  prepared  as  above  described),  and  if  any  blood 
vessels  have  been  torn  they  should  be  tied  with  silk  ligatures,  though 
they  may  not  be  bleeding  at  the  time.  The  wound  should  be  scrubbed 
off  with  soap  and  warm  water,  and  then  with  grain  alcohol  (not 
wood  alcohol),  and  finally  with  a  solution  of  bichloride  of  mercury 
(1  to  5,000).  Thick  layers  of  clean  (aseptic)  gauze  dressing  should 
then  be  applied  and  held  in  place  by  means  of  a  bandage.  If  the 
wound  is  large,  the  edges  of  a  portion  of  it  may  be  carefully  drawn 
together.  A  strand  of  aseptic  gauze  should  then  be  placed  in  the 
bottom  of  the  wound  and  allowed  to  project  through  the  opening, 
so  that  it  may  drain  into  the  layers  of  gauze  placed  on  top. 

When  dressings  become  soaked  with  the  discharges  they  do  more 
harm  than  good;  they  must,  therefore,  be  changed  as  soon  as  the 
soaking  is  apparent,  and  the  change  must  be  made  with  all  the 
aseptic  precautions  exercised  in  the  operation.  Clean  hands,  clean 
instruments,  clean  dressings,  clean  everything,,  are  the  watchwords. 
Water  that  has  been  boiled  is  perfectly  safe,  and  boiling  is  the  best 
disinfectant  for  instruments. 

The  stitches  may  be  removed  from  a  wound  about  the  fifth  or 
sixth  day,  or  earlier  if  they  begin  to  cut  or  irritate.  If  the  wound 
is  large,  they  need  not  all  be  taken  out  at  the  same  time. 

Gunshot  wounds  are  frequently  more  or  less  contused  and  lacer- 
ated, and  unless  one  of  the  main  blood  vessels  is  divided,  or  the  lung 
or  other  internal  organ  penetrated,  the  bleeding  is  slight.  The 
general  treatment  for  such  wounds  is  about  the  same  as  for  other 


40  MEDICAL  HANDBOOK. 

lacerated  wounds  already  described,  but  if  the  materials  for  thor- 
oughly cleansing  the  wound  are  not  readily  at  hand,  and  if  there 
is  not  much  bleeding,  the  wound  had  better  be  let  alone,  simply  cov- 
ering it  with  aseptic  gauze  until  the  patient  can  be  placed  under  the 
care  of  a  surgeon.  No  effort  should  be  made  by  anyone  other  than  a 
physician  to  find  or  feel  the  bullet  or  other  missile  by  a  probe  or  other 
instrument,  especially  if  the  wound  is  in  the  chest  or  abdomen,  as 
there  is  more  danger  in  searching  for  it  than  in  leaving  it  where  it 
may  be  lodged.  The  wound  made  by  a  Mauser  bullet  not  infre- 
quently looks  as  if  made  by  a  large  needle — a  punctured  wound. 

Punctured  wounds  are  made  by  a  narrow  sharp-pointed  instru- 
ment, e.  g.,  pin,  needle,  dagger,  or  point  of  a  knife  or  stiletto.  They 
may  penetrate  to  any  depth,  and  if  the  instruments  are  clean  and 
no  large  blood  vessels  or  nerves  have  been  wounded,  withdrawal 
of  the  instrument  may  be  followed  by  rapid  recovery.  But  if  such 
wounds  are  produced  by  irregularly  shaped  blunt  instruments,  or 
by  nails  or  splinters  of  wood,  and  especially  if  contaminated  by  any 
poisonous  material,  the  walls  of  the  wound  track  are  at  once  dan- 
gerously contused,  lacerated,  and  infected,  and  if  large  blood  vessels, 
nerves,  or  other  organs  have  been  injured  the  danger  is  very  great, 
and  the  patient  should  be  placed  under  the  care  of  a  surgeon  as 
soon  as  possible,  for  unless  the  master  or  keeper  is  sufficiently  famil- 
iar with  the  nature  of  such  wounds  and  the  anatomy  of  the  part 
to  lay  it  open  to  the  bottom  by  additional  incisions,  he  can  do  little 
more  than  apply  aseptic  dressings  to  the  surface  and  keep  the  patient 
quiet. 

BURNS  OR  SCALDS. 

Burns  or  scalds  are  serious  and  dangerous  to  life  in  proportion 
to  the  extent  and  depth  of  the  injury.  A  burn  covering  a  large 
area  and  producing  mere  reddening  and  swelling  of  the  skin  is  as 
serious  as  a  burn  one-half  the  size  in  which  the  skin  is  destroyed. 
The  danger  is  from  shock,  from  fever  following  reaction,  from  hem- 
orrhage following  sloughing,  and  from  congestion  and  inflammation 
of  internal  organs.  Burns  of  slight  extent  or  moderate  degree  are 
not  so  dangerous,  and  most  of  the  cases  commonly  met  with  will 
recover.  But  all  cases  require  careful  treatment. 

Treatment. — For  shock  give  strychnia  sulphate,  one-fortieth  grain. 
In  slight  or  moderate  burns  apply  clean  cloths  wet  with  warm  satu- 
rated solution  of  bicarbonate  of  soda  (baking  soda).  In  severe 
burns  cut  away  the  clothing,  avoid  exposure  to  cold,  wash  the 
part  with  warm  saturated  solution  of  bicarbonate  of  soda,  or  with 
solution  of  boric  acid.  The  parts  burned  or  the  entire  body,  except 
the  head,  may  be  kept  immersed  in  tepid  or  warm  water  for  days. 


INJUEIES.  41 

Prick  the  blister  with  a  clean  (aseptic)  needle,  but  do  not  remove 
the  cuticle.  Sprinkle  with  dry  bicarbonate  of  soda  or  with  powdered 
boric  acid  and  dress  the  part  with  thick  layers  of  clean  (aseptic) 
cotton.  (Cotton  may  be  rendered  aseptic  by  heating  it  in  an  oven 
to  a  point  just  short  of  burning.)  The  dressing  should  be  changed 
only  when  absolutely  necessary.  Keep  the  patient  quiet  and  his 
bowels  active.  Pain  or  restlessness  may  be  relieved  by  laudanum, 
20  drops,  repeated  in  two  hours  if  necessary.  Carron  oil  (equal 
parts  of  olive  oil  and  limewater)  is  an  old  remedy  that  affords  con- 
siderable relief  if  applied  to  the  surface.  Petrolatum  is  also  some- 
times used.  The  scars  resulting  from  burns  and  scalds  always  con- 
tract, and  in  severe  cases  terrible  deformities  are  produced.  These 
may  be  prevented  to  some  extent  by  active  and  passive  motion  and 
by  splints. 

EFFECTS  OF  COLD— FROSTBITE. 

Severe  cold  depresses  the  action  of  the  heart — suspends  the  circu- 
lation. These  effects  are  first  noticed  in  the  ears,  nose,  fingers,  and 
toes.  Numbness  and  tingling  are  the  first  symptoms,  then  loss  of 
sensation.  If  not  too  long  exposed,  the  circulation  may  be  restored 
by  proper  treatment.  But  if  the  exposure  is  long  continued,  or  if 
the  cold  is  very  intense,  the  parts  are  hopelessly  frozen  and  gangrene 
will  be  the  result.  The  parts  may  look  all  right  for  a  few  days  after 
reaction,  and  then  become  discolored,  bluish,  and  finally  black. 
Another  effect  of  extreme  cold  is  an  overpowering  sense  of  drowsi- 
ness, but  to  lie  down  under  such  circumstances  and  go  to  sleep  is 
almost  certain  death. 

Treatment  of  frostbites. — 1.  Do  not  bring  the  patient  to  the  fire 
nor  bathe  the  parts  in  warm  water. 

2.  If  snow  be  on  the  ground,  or  accessible,  take  a  woolen  cloth  in 
the  hand,  place  a  handful  of  snow  upon  it,  and  gently  rub  the  frozen 
part  until  the  natural  color  is  restored.     In  case  snow  is  not  at  hand, 
bathe  the  part  gently  with  a  woolen  cloth  in  the  coldest  fresh  water 
obtainable — ice  water  if  practicable. 

3.  In  case  the  frostbite  is  old  and  the  skin  has  turned  black  or 
begun  to  scale  off,  do  not  attempt  to  restore  its  vitality  by  friction, 
but  apply  a  little  cotton,  after  which  wrap  the  part  loosely  in  flannel. 

4.  In  the  case  of  a  person  apparently  dead  from  exposure  to  cold, 
friction  should  be  applied  to  the  body  and  the  lower  extremities,  and 
artificial  respiration  practiced  as  in  cases  of  the  apparently  drowned. 
As  soon  as  the  circulation  appears  to  be  restored,  administer  strychnia 
sulphate  one- fortieth  grain.    Even  if  no  signs  of  life  appear,  friction 
should  be  kept  up  for  a  long  period,  as  instances  are  on  record  of 
recovery  after  several  hours  of  suspended  animation. 


42  MEDICAL  HANDBOOK. 

SCALP  WOUNDS. 

Treatment. — Examine  the  parts  carefully;  clip  and  shave  the  hair 
from  a  wide  area  about  the  wound;  wash  with  warm  water;  draw 
the  edges  of  wound  together  with  the  fingers  and  apply  absorbent 
cotton  with  adhesive  plaster.  Stitches  of  silk  ligature  may  be  used. 
All  the  precautions  given  on  page  39  as  to  cleanliness  of  hands  and 
instruments  must  be  followed.  The  stitches  must  not  be  drawn  too 
tightly,  the  edges  simply  brought  together.  Bleeding  is  often  severe, 
but  usually  stops  under  pressure  or  after  the  stitches  have  been  put 
in  and  the  dressing  applied;  but  if  an  artery  spurts  it  must  first 
be  tied.  A  few  strands  of  silk  ligature  may  be  put  in  at  the  most 
dependent  part  of  the  wound  for  drainage,  but  this  is  not  usually 
necessary.  No  part  of  the  scalp  should  be  removed,  no  matter  how 
slender  its  attachment.  If  replaced  it  will  probably  retain  its  vital- 
ity. Dress  the  wound  with  a  pad  of  clean  (aseptic)  gauze  and  apply 
a  bandage,  not  tightly. 

The  stitches  should  be  removed  the  sixth  day.  Unconsciousness 
and  bleeding  from  the  ears  are  grave  symptoms,  indicating  fracture 
of  base  of  skull  or  rupture  of  blood  vessels  within. 

INJURIES  TO  THE  CHEST. 

Contusions  of  the  chest  and  fracture  of  the  ribs  are  of  frequent 
occurrence,  and  it  is  not  always  easy  to  determine  in  a  given  case 
of  injury  to  the  chest  walls  whether  fracture  actually  exists,  but  if 
in  doubt,  give  the  patient  the  benefit,  and  treat  the  case  as  one  of 
fracture. 

Fracture  involving  several  ribs,  or  one  or  more  ribs  at  two  points 
each,  is  not  difficult  to  make  out,  for  in  addition  to  the  sharp  pain 
in  breathing,  and  the  bloody  expectoration  which  is  present  in  cases 
where  the  lung  is  wounded,  there  is  considerable  deformity. 

In  single  fracture  of  the  ribs  there  is  little  or  no  deformity,  but 
the  pain  in  breathing  and  coughing  is  apt  to  be  severe.  Pressure 
on  the  broken  bone  is  also  quite  painful,  and  if  a  hand  is  placed 
over  the  seat  of  injury,  or  a  finger  on  either  side  of  the  fracture,  and 
the  patient  requested  to  cough,  a  grating  may  be  felt,  unless  the  rib 
is  covered  with  heavy  muscle  or  fat,  when,  as  before  stated,  it  may 
be  difficult  if  not  impossible  to  say  whether  or  not  fracture  exists. 

Treatment. — Strips  of  adhesive  plaster,  3  or  4  inches  wide  and 
long  enough  to  extend  from  the  spine  to  the  middle  or  a  little  beyond 
the  middle  of  the  breastbone,  should  be  applied  horizontally  from 
the  armpits  downward  over  the  whole  side  of  the  chest.  Each  piece 
to  be  forcibly  applied  at  the  end  of  expiration  (when  the  lungs 
are  empty)  and  to  overlap  the  preceding  piece  to  one-half  its  width. 


INJURIES.  43 

Any  slight  outward  deformity  at  the  seat  of  fracture  may  be  reduced 
by  pressure  before  the  plaster  is  applied  at  that  point.  A  broad 
bandage  should  then  be  applied  around  the  chest  from  below  upward. 

INJURIES  TO  THE  BACK. 

Sprains  of  the  back  are  of  all  degrees  of  severity.  In  slight 
sprains  the  muscles  alone  are  involved,  and  beyond  a  temporary 
stiffness,  and  pain  over  a  limited  area,  there  may  be  no  trouble. 

In  severe  sprains  it  is  difficult  to  determine  the  degree  of  injury. 
Marked  pain  and  stiffness  are  always  present,  and  not  infrequently 
paralysis  of  the  legs,  bowels,  and  bladder.  Death  may  be  produced 
by  shock,  or  occur  later  from  secondary  effects  of  the  injury. 

Treatment. — Rest  in  bed.  Epsom  salts  to  move  the  bowels;  rub 
the  back  with  soap  liniment.  Apply  a  binder  or  bandage  around  the 
body  from  the  hips  up  over  the  chest.  See  that  the  bladder  does  not 
become  distended.  If  necessary,  introduce  a  catheter  and  draw  off  the 
urine.  Boil  catheter  for  five  minutes  before  using. 

BROKEN  BONES  (FRACTURES). 

There  are  many  varieties  of  fracture.  A  fracture  is  said  to  be 
simple  where  there  is  no  open  wound  directly  over  the  bone  injury; 
compound  when  there  is  an  opening  in  the  skin  and  soft  parts  extend- 
ing down  to  the  broken  bone ;  comminuted  when  the  bone  is  broken 
in  several  places;  complicated  when  associated  with  other  injuries,  as 
dislocation  of  the  joint  or  rupture  of  the  main  artery  of  the  limb; 
impacted  when  one  fragment  is  driven  into  another. 

The  reliable  signs  or  symptoms  of  simple  fracture  are  deformity, 
crepitus  (grating)  when  the  ends  of  the  broken  bone  are  rubbed 
together,  unnatural  or  false  point  of  motion,  and,  if  in  the  shaft  of  a 
long  bone,  shortening,  due  to  the  fact  that  in  most  cases  the  break  is 
obliquely  across  the  bone  and  the  fragments  override.  But  in  trans- 
verse fracture,  where  the  break  is  straight  across  the  bone  at  a  right 
angle  with  the  long  axis  of  the  bone,  or  in  a  fracture  near  a  joint, 
there  may  be  no  shortening  and  no  deformity.  In  fractures  of  cer- 
tain boneSj  as  the  skull  or  the  spine,  or  in  an  impacted  fracture,  there 
may  be  no  motion.  In  fracture  of  the  kneepan  or  the  elbow  the  frag- 
ments are  pulled  apart  by  the  muscles,  so  there  is  lengthening  instead 
of  shortening. 

Examination  should  always  be  made  as  soon  as  possible  after  the 
accident.  Under  the  most  favorable  circumstances  it  is  difficult  in 
some  cases  to  determine  whether  a  bone  is  broken  or  not,  and  the 
difficulty  is  greatly  increased  if  the  examination  is  delayed  until 
inflammatory  swelling  has  set  in.  In  fractures  of  the  extremities  the 
sound  limb  should  always  be  placed  alongside  the  injured  one  for 


44  MEDICAL,  HANDBOOK. 

comparison.  The  shortening  in  fracture  of  the  thigh  may  be  from 
1  to  3  inches,  but  it  must  not  be  forgotten  that  in  some  persons  there 
is  a  natural  difference  of  as  much  as  half  an  inch  in  length  of  the 
pair  of  legs ;  and  a  limb  may  be  otherwise  naturally  deformed  which 
should  not  be  mistaken  for  accidental  deformity.  In  the  leg  below 
the  knee  there  are  two  parallel  bones  (tibia  and  fibula).  In  simple 
fracture  affecting  only  one  of  these  bones  the  deformity  and  crepitus 
are  less  marked ;  and  the  same  may  be  said  of  the  forearm,  if  frac- 
ture exists  in  only  one  of  the  bones  (radius  or  ulna).  If  both  bones 
of  the  leg  (tibia  and  fibula)  or  of  the  arm  (radius  and  ulna)  are 
affected,  there  may  be  considerable  deformity,  and  it  is  a  curious  fact 
that  fracture  of  these  bones  seldom  occurs  on  the  same  level.  The 
distance  between  the  fractures  may  be  from  1  to  3  inches,  usually 
greater  in  the  leg  than  in  the  forearm. 

Crepitus  (the  sound  heard,  or  feeling  imparted  to  the  hand  when 
the  broken  ends  of  the  bone  are  rubbed  together)  is  a  valuable  symp- 
tom of  fracture,  but  it  can  not  always  be  detected,  and  when  other 
marked  signs  or  symptoms  are  present,  need  not  and  should  not  be 
looked  for.  In  fractures  of  the  leg  below  the  knee  or  of  the  forearm, 
involving  only  one  of  the  bones:  it  is  hard  to  make  out  because  of  the 
difficulty  of  rubbing  the  broken  ends  together,  and  when  much  swell- 
ing exists  the  difficulty  is  increased,  or  a  false  crepitus  may  be  pro- 
duced. In  impacted  fractures,  which  occur  chiefly  in  the  neck  of  the 
thigh  bone,  no  effort  should  be  made  to  obtain  crepitus.  The  impor- 
tant thing  in  such  cases  is  not  to  disturb  the  impacted  fragments,  for 
if  pulled  apart  recovery  is  rendered  more  difficult. 

"FRACTURE  OF  THE  LOWER  JAW. 

Fracture  of  the  lower  jaw  may  be  simple,  compound,  or  com- 
minuted. The  mucous  membrane  of  the  mouth  is  nearly  always 
lacerated,  the  bleeding  is  usually  not  severe  (oozing  only),  but  there 
may  be  hemorrhage  from  an  artery  (the  inferior  dental),  saliva  drib- 
bles from  the  half -open  mouth,  the  teeth  may  be  out  of  line,  pain  is 
apt  to  be  severe,  there  may  be  considerable  deformity  and  a  false 
point  of  motion. 

Treatment. — Restore  the  parts  to  the  natural  position  and  keep 
them  at  perfect  rest,  first  washing  out  the  mouth  with  hot  water  to 
cleanse  it  and  check  bleeding.  If  the  bleeding  is  very  severe,  pressure 
should  be  made  by  the  thumb  or  finger  for  a  time  on  the  bleeding 
point  if  possible,  or  on  the  large  artery  (carotid)  on  the  side  of  the 
neck,  which  may  be  easily  located  by  the  pulsation.  Loose  teeth  or 
pieces  of  bone  should  not  as  a  rule  be  removed.  Mold  them  into 
place,  bring  the  teeth  and  jaw  into  natural  line,  and  keep  them  so  by 
a  pasteboard  or  binder's  board  splint  (figs.  2  and  3),  held  in  place 
by  a  four-tailed  bandage. 


INJURIES.  45 

Take  a  piece  of  pasteboard  about  8  or  9  inches  long  by  4  inches 
wide  and  cut  it  up  in  the  middle  from  each  end  to  within  about  an 
inch  or  inch  and  a  half  from  the  center,  according  to  the  size  of  the 
chin.  Dip  it  in  hot  water  and  mold  it  to  the  chin  and  jaw.  (Fig.  3.) 
Remove  it  carefully,  line  it  with  absorbent  cotton,  reapply  it,  and 
retain  it  in  place  by  the  four-tailed  bandage.  (Fig.  4.)  The  four- 
tailed  bandage  may  be  made  in  the  following  manner:  Take  a 
bandage  or  piece  of  heavy  muslin  about  3  inches  wide  and  a  yard  or 


FIG.  2. 

FIG. 


T 


FIG.  4. 


FIG.  5. 


Fig.  2  shows  the  pasteboard  or  leather  as  cut  out ;  Fig.  3  shows  the  same  molded  to  fit 
the  chin  and  jaw  ;  Fig.  4  is  a  four-tailed  bandage ;  and  Fig.  5  shows  how  they  are 
applied. 

a  yard  and  a  half  long.  In  the  middle  of  this  or  a  little  to  one  side  of 
the  middle  cut  a  slit  large  enough  for  the  point  of  the  chin ;  place  the 
narrower  portion  upward,  then  tear  the  bandage  down  the  middle 
from  each  end  to  within  2  inches  of  the  slit,  so  as  to  make  four  ends  or 
tails ;  then  carry  the  two  upper  ends  backward  and  tie  at  the  nape  of 
the  neck ;  carry  the  two  lower  tails  to  the  top  of  the  head  and  tie  in  a 
knot.  (Fig.  5.)°  The  ends  of  the  knots  at  nape  of  neck  and  top  of 
head  may  then  be  tied  together  to  hold  them  in  place  and  prevent 

tt  The  application  of  the  bandage  as  directed  causes  a  lapping  of  the  tails,  which  is  not 
shown  in  the  plate.  The  object  of  the  lapping  is  to  prevent  the  tearing  of  the  bandage  at 
the  angle  and  make  it  much  stronger. 


46  MEDICAL,   HANDBOOK. 

slipping.     If  necessary,  a  bandage  may  also  be  carried  around  the 
head  and  secured  with  pins. 

If  the  parts  can  not  be  kept  in  place  by  the  methods  described,  the 
teeth  may  be  fastened  together  with  silver  wire  passed  between  the 
teeth  on  each  side  of  the  break  and  twisting  the  ends  together.  Feed 
the  patient  on  liquid  food  through  a  rubber  tube  introduced  behind 
the  last  tooth  or  through  any  space  left  by  the  loss  of  a  tooth,  the 
object  being  to  prevent  movement  of  the  jaw.  Wash  out  the  mouth 
frequently  with  hot  water,  and,  if  necessary,  change  the  dressing 
every  two  or  three  days  until  the  end  of  about  the  sixth  or  eighth 
week,  when,  if  all  goes  well,  union  will  be  complete,  and  the  splint  and 
bandage  may  discontinued. 

FRACTURE  OF  THE  THUMB  AND  FINGERS. 

Treatment. — Put  the  fragments  in  place  by  extension  and  pressure ; 
then  cut  a  piece  of  pasteboard,  leather,  cigar  box,  or  thin  board  long 
enough  to  extend  from  above  the  wrist  joint  to  a  little  below  the  ends 
of  the  fingers  and  a  little  wider  than  the  hand.  Cover  the  board  with 
lint  or  any  soft  cloth,  place  the  palm  of  the  hand  flat  upon  it,  and 
apply  a  bandage  around  the  whole  hand  and  wrist. 

If  pasteboard  or  leather  be  used,  it  may  first  be  dipped  into  hot 
water  and  then  molded  to  the  shape  of  the  thumb  or  finger  and  palm 
of  the  hand,  then  lined  or  covered  with  cloth,  and  bandaged  as  above, 
care  being  taken  not  to  make  the  bandage  too  tight. 

FRACTURE  OF  THE  FOREARM. 

The  forearm  extends  from  the  wrist  to  the  elbow.  When  both 
bones  are  broken  there  is  apt  to  be  marked  displacement  and  crepi- 
tus  (grating  felt  by  rubbing  the  broken  ends  of  the  bone  together). 
When  only  one  bone  is  broken  the  signs  and  symptoms  are  not  so 
clear,  but  by  careful  examination  the  nature  of  the  injury  may  be 
determined.  When  fracture  of  one  of  the  bones  (the  radius)  occurs 
near  the  wrist  joint  (Colles'  fracture)  there  is  generally  marked 
deformity  resembling  a  silver  fork  in  shape. 

Treatment. — Prepare  two  splints  of  thin  board  or  heavy  binder's 
board,  one  for  the  palmar  side  of  the  forearm  long  enough  to  extend 
from  the  elbow  to  the  palm  of  the  hand.  The  other  for  the  back  of  the 
forearm  may  be  a  little  shorter,  but  should  extend  from  the  elbow  to 
below  the  wrist  back  of  the  hand.  Both  splints  must  be  a  little  wider 
than  the  arm  so  as  to  prevent  the  bones  from  being  drawn  together 
by  the  bandage.  Line  the  splints  with  several  layers  of  lint  or  with 
absorbent  cotton  or  soft  cloth.  If  deformity  exists,  reduce  it  by  ex- 
tension and  counter  extension.  Pull  on  the  hand  while  an  assistant 
holds  or  pulls  at  the  elbow,  and  gently  press  the  projecting  fragment 
to  its  normal  position.  Place  the  arm  between  the  splints  in  such  a 


INJURIES.  47 

way  that  when  bent  at  an  angle  the  thumb  will  point  directly  upward 
and  the  palm  of  the  hand  lie  flat  against  the  chest.  Apply  a  roller 
bandage  outside  and  around  the  splints  from  fingers  to  elbow,  being 
careful  not  to  make  it  too  tight,  and  hang  the  forearm  in  a  broad 
sling. 

Another  way  to  hold  the  splints  in  place  is  to  apply  strips  of  adhe- 
sive plaster  around  them,  one  at  the  upper  and  the  other  at  the  lower 
end.  If  swelling  occurs,  the  bandage  must  be  loosened.  The  splints 
should  be  worn  six  weeks  or  two  months,  and  passive  motion — that  is, 
gently  bending  and  straightening  of  the  fingers  with  the  other  hand — 
must  be  made  every  few  days  to  prevent  stiffening. 

FRACTURE    OF    THE    ARM  (BETWEEN    THE    ELBOW  AND 

SHOULDER). 

Treatment. — Splints  of  binder's  board  dipped  in  water  and  molded 
to  the  part  or  any  thin  board  will  answer  the  purpose  if  properly 
lined  or  padded.  Place  one  splint  on  the  outside  of  the  arm  extend- 
ing from  the  elbow  to  the  shoulder  (fig.  6),  an  internal  angular  splint 
extending  from  the  armpit  to  the  fingers  on  the  inner  side  (fig.  7), 
and  if  need  be  a  narrower  splint  in  front  and  one  behind,  and  the 
whole  surrounded  with  a  well-fitted  bandage.  Support  the  forearm 
by  a  sling,  but  leave  the  elbow  free.  (Fig.  8.) 

If  much  swelling  occurs,  all  bandages  must  be  loosened. 

The  splint  should  be  worn  about  eight  weeks.  Under  the  most 
favorable  circumstances,  after  fracture,  this  bone  (the  humerus) 
sometimes  fails  to  unite.  At  least  once  a  week  the  joints  should  be 
moved  to  prevent  stiffness. 

Fractures  of  the  arm  (of  the  humerus)  at  or  near  the  elbow  joint 
or  shoulder  joint  are  frequently  very  difficult  to  make  out,  even  by 
the  most  skillful  surgeon,  especially  if  some  time  has  elapsed  since 
the  injury  was  received;  and  the  treatment  of  necessity  is  equally 
difficult. 

If  near  or  at  the  elbow  joint,  and  if  there  is  much  pain,  heat,  and 
swelling,  as  is  apt  to  be  the  case,  cold  applications  should  be  applied, 
and  the  arm  laid  upon  a  pillow  until  the  swelling  has  gone  down.  A 
rectangular  splint  of  binder's  board  or  leather  should  then  be  dipped 
in  hot  water  and  applied  to  the  inner  side  of  the  arm  and  forearm. 
The  splint  should  be  wide  enough  to  extend  nearly  halfway  around 
the  arm.  It  must  be  well  padded  and  held  in  place  by  a  roller  band- 
age, and  the  forearm  supported  by  a  sling. 

Fracture  of  the  humerus  near  the  shoulder  joint  may  be  treated  by 
means  of  a  shoulder  cap  of  thick  pasteboard  molded  to  fit  the  shoul- 
der and  extending  nearly  to  the  elbow,  or  a  splint  on  the  outer  side 
of  the  arm,  and  a  pad  of  folded  lint  or  of  absorbent  cotton  under  the 
arm  (in  the  armpit).  The  shoulder  cap  or  splint  should  be  padded 


48 


MEDICAL,  HANDBOOK. 


the  same  as  in  any  other  fracture  and  the  whole  surrounded  by  a 
roller  bandage  which  encircles  the  chest,  binding  the  arm  to  the  chest. 
If  the  deformity  is  marked,  a  second  and  shorter  splint  may  be  placed 
on  the  inner  side  of  the  arm,  taking  care  that  the  upper  end  does 


Fig.  6. 


Fig.  7. 


FIG.  8. 


Fig.  6  is  the  outside  splint  to  extend  from  shoulder  to  elbow  ;  Fig.  7  is  the  internal 
angular  splint  to  be  placed  between  the  arm  and  the  body ;  and  Fig.  8  shows  the  two 
splints  applied  with  a  bandage  around  them  and  the  arm  from  the  fingers  to  the 
shoulder,  with  a  sling  properly  arranged  to  support  the  forearm  but  not  to  raise  the 
elbow. 

not  press  too  hard  into  the  armpit.    The  arm  should  then  be  bound 
to  the  chest  by  a  board  bandage. 

After  the  application  of  any  apparatus  for  fracture  of  the  arm  or 
forearm,  the  circulation  should  be  carefully  watched  by  feeling  the 
pulse  at  the  wrist.  If  it  can  not  be  felt,  or  if  the  fingers  swell,  the 
bandages  should  be  removed  and  reapplied  less  tightly. 


INJURIES.  49 

FRACTURE  OF  THE  THIGH. 

The  thigh  bone  (femur)  extends  from  the  hip  to  the  knee.  Frac- 
ture of  this  bone  may  occur  in  any  portion  of  the  shaft,  but  the  most 
common  seat  of  fracture  is  about  the  middle  or  the  middle  third. 
Fractures  high  up  near  the  hip  joint  are  frequently  very  difficult  to 
make  out,  and  the  results  of  treatment  in  such  cases,  even  under  the 
care  of  skillful  surgeons,  are  not  always  satisfactory. 

In  fracture  of  the  middle  or  middle  third  of  the  bone,  the  deform- 
ity is  usually  produced  by  the  lower  fragment  (the  broken  end  of 
the  lower  portion  of  the  bone)  being  drawn  up  behind  and  to  the 
inner  side  of  the  upper  fragment ;  the  weight  of  the  limb  then  causes 
rotation  and  the  foot  and  toes  are  turned  outward. 

If  the  fracture  is  a  little  higher  up,  displacement  is  shown  by  the 
upper  fragment,  which,  by  the  action  of  the  muscles,  is  thrown 
strongly  forward  and  outward.  In  either  case  there  are  complete 
loss  of  power,  shortening  to  the  extent  of  1  to  2  or  3  inches,  pain  on 
the  slightest  movement,  crepitus  (grating)  if  the  broken  ends  of  the 
bone  are  rubbed  together,  and  abnormal  motion. 

In  impacted  fractures,  which  are  met  chiefly  at  or  near  the  hip 
joint,  the  shortening  may  be,  and  usually  is,  less  marked.  Loss  of 
power  is  usually  complete,  but  not  always.  -Patients  have  been  known 
to  stand  and  even  walk  a  few  steps.  Injuries  of  this  kind  require 
the  greatest  care;  the  limbs  should  be  handled  very  carefulty.  If 
on  slight  traction  or  manipulation  crepitus  is  not  felt,  no  further 
attempt  should  be  made  to  obtain  this  symptom,  for  in  doing  so  the 
impacted  bones  may  be  pulled  apart,  which  is  to  be  avoided  unless 
especially  directed  by  a  skillful  surgeon. 

Treatment. — In  the  absence  of  a  physician,  about  all  that  may 
reasonably  be  expected  to  be  done  in  impacted  fracture  is  to  apply 
a  broad  bandage  around  the  hips  and  place  the  patient  in  a  good  bed 
on  a  firm  mattress  and  make  lateral  support  by  means  of  sand  bags, 
one  on  the  outside  long  enough  to  reach  from  the  upper  end  of  the 
hip  bone  to  the  foot,  the  other  along  the  inner  side  of  the  leg  from 
the  crotch  to  the  foot.  Fill  the  bags  three-quarters  full  of  dry  sand. 
Keep  the  leg  straight,  toes  upward. 

Treatment  of  nonimpacted  fracture  of  the  thigh  bone  at  or  near 
the  hip  joint. — Place  both  legs  on  the  double-inclined  plane,  or  make 
extension  and  fix  the  limb  in  the  straight  position  by  means  of  a  long 
splint  (a  splint  extending  from  the  armpit  to  the  foot),  or  by  the 
weight  and  pulley,  or  by  the  long  splint  and  the  weight  and  pulley 
combined,  in  the  manner  now  about  to  be  explained  in  connection 
with  the 

Treatment  of  fractures  of  the  shaft  of  the  thigh  bone. — In  frac- 
ture of  the  shaft-  of  this  bone  the  signs  and  symptoms,  as  already 
21824°— 12 4 


50 


MEDICAL,  HANDBOOK. 


stated,  are  usually  well  marked.  If  the  fracture  is  at  the  upper  end 
or  in  the  upper  third  of  the  bone,  especially  if  the  upper  fragment  is 
tilted  forward,  the  double-inclined  plane  (fig.  9)  well  padded  or 
covered  with  pillows,  with  weight  and  pulley  attached  by  means  of 
adhesive  plaster  stuck  to  each  side  of  the  thigh  as  far  as  the  knee, 


FIG.  9. — Shows  a  double-inclined  plane  with  the  weight  and  pulley — 1  is  the  double-in- 
clined plane,  2  and  3  are  circular  pieces  of  adhesive  plaster  to  prevent  4,  the  longi- 
tudinal strip  on  each  side  of  the  thigh,  from  slipping;  5  and  6  are  the  pulley  and 
weight. 

affords  the  easiest  and  probably  the  best  means  of  treatment.  But 
in  the  majority  of  cases  when  the  fracture  is  farther  down,  about  the 
middle  or  in  the  middle  third  of  the  bone,  the  weight  and  pulley  with 
the  leg  and  thigh  in  a  straight  line  (fig.  10),  or  the  weight  and  pul- 
ley and  long  splint  combined  (fig.  11)  are  better  adapted  if  properly 
applied.  Sand  bags  may  also  be  used  in  connection  with  any  of  the 


FIG.  10.— Shows  the  weight  and  pulley  applied  with  the  leg  and  thigh  in  the  straight  posi- 
tion— the  adhesive  strips  being  attached  to  the  leg  as  well  as  the  thigh. 

straight  splints  placed  alongside.  In  all  cases  the  fracture  should  be 
reduced  by  gradually  pulling  and  carefully  pressing  the  broken  bones 
into  their  natural  position.  In  addition  to  the  splints  already  men- 
tioned, short  splints  of  narrow  strips  of  thin  board  or  binder's  board 
should  be  applied  directly  over  the  seat  of  fracture. 


INJUEIES. 


51 


If  a  double-inclined  plane  is  not  at  hand,  two  broad  pieces  of 
board  may  be  nailed  together  at  a  suitable  angle  and  used  instead, 
always  property  padded  or  covered  with  pillows. 

The  weight  and  pulley  (figs.  10  and  12). — The  weight  and  pulley 
are  applied  as  follows:  Measure  the  distance  from  1  inch  below  the 
crotch  to  a  point  4  inches  below  the  foot.  Cut  a  strip  of  adhesive 
plaster  exactly  twice  as  long  as  the  distance  just  measured  and  3 


FIG.  11. — Shows  the  long  lateral  splint  extending  from  the  armpit  to  a  point  a  little  below 
the  foot.  It  is  bandaged  to  the  body  and  the  lower  extremity,  and  may  be  used  with 
the  weight  and  pulley. 

inches  wide,  and  stretch  it  on  a  table  or  on  the  floor,  with  the 
sticky  side  up.  Get  a  block  of  wood  4  inches  long,  about  3  inches 
wide,  and  about  ^  inch  thick,  with  a  hole  bored  through  the  center 
large  enough  to  admit  a  large  cord.  P-lace  the  block  exactly  in 
the  center  of  the  long  strip  of  adhesive  plaster.  Cut  another  strip 
of  plaster  the  width  of  the  first  and  18  inches  long,  and  place  it 
on  the  first  strip,  sticky  surfaces  together,  so  as  to  include  the  block 


GO 

c 


— D 
FIG.    12. 

A  shows  the  long  strip  of  adhesive  plaster ;  B  shows  the  short  strip.  C  is  the  block  of 
wood  4  x  3  x  \  inches  with  a  hole  in  the  center.  D  shows  the  block  placed  between  the 
two  strips  of  plaster,  all  ready  for  application  to  the  leg  or  thigh. 

between  the  center  of  each.  Thus  a  stirrup  is  made  and  the  plaster 
kept  from  sticking  to  the  ankle  bones,  because  it  would  make  them 
sore.  The  long  strip  of  plaster  on  each  side  of  the  stirrup  is  then 
applied  to  the  leg  and  thigh  after  shaving  on  each  side  the  surface 
to  which  it  is  to  be  applied,  extending  from  a  point  just  above  the 
ankle  bone  to  a  point  about  1  inch  below  the  crotch  on  the  inner 
side  and  to  the  same  level  on  the  outer  side,  being  careful  to  keep  the 


52  MEDICAL,  HANDBOOK. 

block  square  when  the  two  ends  of  the  plaster  are  stuck  to  the  limb. 
A  roller  bandage  is  then  applied  over  the  plaster  from  the  ankle 
up.  A  strong  cord  is  then  passed  through  the  hole  in  the  block 
and  knotted  so  that  it  can  not  slip  through,  the  other  end  being 
passed  over  a  pulley  attached  to  the  foot  of  the  bed  or  elsewhere,  as 
may  be  convenient,  on  a  line  with  the  extended  limb,  and  a  weight 
of  from  5  to  30  pounds,  as  may  be  necessary  or  comfortable  to  the 
patient,  gradually  increased,  attached.  The  same  kind  of  apparatus 
may  be  used  with  the  double-inclined  plane,  except  that  the  plaster 
is  applied  only  to  the  thigh,  the  stirrup  coming  just  below  the  bent 
knee. 

Counter  extension  may  be  obtained  by  raising  the  foot  end  of  the 
bed  on  blocks  4  to  6  inches  high.  The  short  splints  should  be  well 
padded  and  extend  well  above  and  below  the  fracture,  and  be  held 
in  place  by  strips  of  plaster  or  bandage. 

The  long  splint  gives  additional  support  and  prevents  outward 
rotation  of  the  leg.  It  should  be  well  padded,  and  have  a  cross- 


FIG.  13. — Shows  a  splint  and  bandage  applied  for  fracture  of  the  kneecap.  A  Is  a  notch 
in  the  board  to  prevent  slipping  of  the  bandage.  B  is  the  end  of  a  bandage  which  is 
to  be  carried  above  the  knee  over  the  bandage  shown  at  A. 

piece  at  the  lower  end  to  keep  it  in  position.  Treatment  will  be 
required  for  a  period  of  eight  to  ten  weeks,  but  the  extension  may 
be  lessened  about  the  end  of  the  sixth  week  and  passive  motion  made 
at  the  knee  joint. 

FRACTURE  OF  THE  KNEECAP. 

Fracture  of  the  kneecap  may  be  transverse,  vertical,  or  oblique. 
The  bone  may  be  broken  into  two  or  more  irregularly  shaped  pieces. 

Symptoms  and  signs. — Loss  of  power,  inability  to  extend  the 
joint  or  raise  the  limb  from  the  bed.  In  the  transverse  variety  the 
fragments  are  widely  separated.  If  seen  soon  after  the  accident, 
the  line  of  fracture — the  gap  between  the  fragments — may  be  seen 
and  felt.  Swelling  rapidly  appears  and  the  signs  are  obscured. 


INJUEIES.  53 

Treatment. — Various  forms  of  apparatus  are  employed,  and  in  hos- 
pital practice  the  injury  is  frequently  treated  by  surgical  operation, 
with  good  result.  The  simplest  form  of  treatment  is  to  place  the 
limb  on  a  long  posterior  splint  (fig.  13)  with  the  foot  raised  so  as 
to  relax  the  thigh  muscles,  or  if  the  patient  is  propped  up  in  bed  by 
pillows  or  a  back  rest,  the  limb  may  be  allowed  to  lie  on  a  level. 

Apply  iced  water  .or  the  ice  bag  for  a  few  days,  until  the  swelling 
and  heat  have  subsided;  then  remove  the  splint  and  apply  a  roller 
bandage.  The  turns  of  the  bandage  below  and  above  the  knee  should 
be  made  in  an  oblique  direction,  figure-of-eight  fashion,  so  as  to  press 
and  hold  the  fragments  of  bone  together,  the  indications  being,  as 
in  other  fractures,  to  restore  the  broken  ends  of  the  bone  to  their 
natural  position  and  keep  them  there.  A  pad  of  cotton  should  be 
placed  in  the  hollow  back  of  the  knee  and  another  smaller  pad  on 
the  front  of  the  thigh  above  the  upper  fragment  before  the  bondage 
is  applied.  The  splint  should  then  be  relined  with  layers  of  dry 
cotton  or  folds  of  lint  and  the  limb  placed  upon  it  as  before,  secured 
by  another  roller  bandage.  If  swelling  or  numbness  of  the  foot  is 
complained  of,  the  bandage  is  too  tight  and  must  be  removed. 

If  the  bandages  become  loose,  as  they  are  apt  to  do  every  few  days, 
they  should  be  reapplied. 

The  long  splint  should  be  worn  about  six  weeks  or  two  months, 
when  it  may  be  replaced  by  a  shorter  molded  splint  of  leather,  felt, 
or  pasteboard  to  prevent  motion  at  the  joint  when  the  patient  may 
be  allowed  to  walk  with  canes  or  crutches.  The  short  splint  should 
be  worn  for  at  least  a  month,  and  then  a  suitably  constructed  knee- 
cap should  be  worn  for  one  year  to  support  the  joint.  More  or  less 
stiffness  of  the  joint  is  to  be  expected. 

FRACTURE  OF  THE  LEG  (BETWEEN  THE  KNEE  AND  ANKLE). 

The  leg  extends  from  the  knee  to  the  ankle  and  has  two  bones, 
tibia  and  fibula. 

Fracture  of  the  leg  may  be  simple  or  compound.  Both  bones  may 
be  broken  or  only  one ;  the  line  of  fracture  may  be  oblique  or  trans- 
verse. When  both  bones  are  broken  at  the  middle  or  lower  third 
the  deformity  is  usually  quite  marked.  The  break  is  apt  to  be  in  an 
oblique  direction  and  at  a  lower  level  in  the  tibia  (the  shin)  than  in 
the  fibula.  In  simple  fracture  of  the  upper  part  of  the  leg  the  de- 
formity may  be  less  marked,  but  if  the  knee  is  involved  there  may  be 
great  swelling  because  of  acute  and  serious  inflammation  of  the 
joint. 

When  the  shaft  of  only  one  bone  (the  tibia  or  fibula)  is  broken 
there  is  not  much  displacement,  because  in  such  case  the  sound  bone 
acts  as  a  side  splint.  Fracture  at  the  lower  end  of  the  tibia  at  the 


54 


MEDICAL  HANDBOOK. 


projection  on  inner  side  of  ankle  is  sometimes  mistaken  for  sprained 
ankle,  and  if  the  small  fragment  of  bone  is  not  accurately  adjusted 
and  kept  in  proper  position  the  result  may  be  a  weak  and  stiff  joint. 
The  fibula  may  be  fractured  at  any  point,  but  the  important  frac- 
ture of  this  bone  is  known  as  "  Pott's  fracture."  (Fig.  14.)  This 
fracture  occurs  about  3  inches  above  the  ankle,  on  outer  side  of  the 
leg,  and  is  accompanied  or  complicated  by  outward  dislocation  of  the 
foot,  and  not  infrequently  by  the  breaking  or  tearing  off  of  the  tip 
of  the  lower  end  of  the  tibia. 


PIG.  14. — Shows  the  appearance  of  the  right  foot  after  a  "  Pott's  fracture." 

Treatment. — If  the  line  of  fracture  is  oblique,  the  limb  must  be 
handled  very  carefully  so  as  to  prevent  injury  to  the  soft  parts  by  the 
sharp  ends  of  the  bone  and  thus  avoid  the  conversion  of  a  simple 
fracture  into  a  compound  one. 

A  Pott's  fracture  should  be  treated  as  follows :  Take  a  board  splint 
long  enough  to  extend  from  the  knee  to  a  few  inches  beyond  the  sole 
of  the  foot.  Pad  the  splint  well,  having  the  lower  end  of  the  pad- 
ding at  least  2  inches  thick,  and  do  not  let  it  extend  quite  to  the  ankle 
joint  below.  Apply  the  splint  to  the  inner  side  of  the  leg  so  that  the 
foot  and  ankle  project  below  the  padding.  The  foot  and  leg  are 


B  A 

FIG.  15. — Shows  the  splint  applied  for  a  "  Pott's  fracture."  A  shows  the  thick  padding 
(3  inches)  ending  just  above  the  ankle.  The  bandage  B  keeps  the  foot  turned  in  and 
prevents  the  tendency  to  outward  displacement. 

then  bandaged  to  the  splint  in  such  a  way  as  to  turn  the  foot  inward 
and  thus  correct  the  outward  displacement.     (Fig.  15.) 

In  all  ordinary  cases  of  simple  fracture  of  the  leg,  unless  a  phy- 
sician is  present,  probably  nothing  better  can  be  done  than  to  place 
the  leg  in  a  fracture  box  (fig.  16)  containing  a  soft  pillow,  and  if 
necessary  an  extra  pad  of  cotton  for  the  heel.  The  side  pieces  of 
the  fracture  box  are  fastened  each  by  two  hinges  to  the  backboard 
so  as  to  be  easily  opened  or  closed.  A  pillow  is  placed  on  the  back- 
board and  after  the  fracture  is  reduced,  by  extension  and  counter 


INJURIES.  55 

extension,  the  leg  is  carefully  placed  upon  the  pillow  and  the  sides 
of  the  box  are  closed  or  drawn  together  closely  enough  to  make  easy 
and  equable  support  to  the  broken  bones.  Two  or  three  holes  should 
be  bored  in  the  upper  edge  of  the  sideboards  so  that  they  may  be  tied 
together,  or  strips  of  bandage  may  be  tied  around  the  box.  Two  mor- 
tise holes  should  be  made  in  the  footboard  for  the  reception  of  strips 
of  adhesive  plaster,  so  that  in  addition  to  the  fracture  box  the  weight 
and  pulley  may  be  applied  to  overcome  any  shortening  or  deformity. 
Another  good  plan  is  to  line  the  backboard  (the  bottom  of  the  box) 
with  a  layer  of  cotton  or  folds  of  lint  and  then  fill  in  and  surround 
the  leg  with  bran. 

In  the  absence  of  any  of  the  apparatus  mentioned,  three  well- 
padded  splints  may  be  applied — one  on  each  side  and  one  on  the  back 
of  the  leg.  But  if  there  is  any  displacement  or  overriding  the  frac- 
ture must  be  reduced  and  held  in  proper  position  while  the  splints 
are  being  applied. 

Whatever  form  of  appliance  is  adopted,  care  must  be  taken  that  the 
foot  is  at  a  right  angle  with  the  leg,  the  toes  pointing  directly  upward. 


FIG.  16. 

The  inner  side  of  the  kneecap,  the  projection  on  the  inner  side  of  the 
ankle,  and  the  inner  side  of  the  big  toe  should  be  on  the  same  line. 

In  the  hospital  or  where  the  patient  is  under  the  care  of  a  surgeon 
a  fixed  dressing  of  plaster  of  Paris  or  silicate  of  soda  may  be  used  to 
the  greatest  advantage  after  the  first  week,  or,  in  some  cases,  from  the 
very  beginning  of  treatment. 

COMPOUND  FRACTURES. 

Compound  fractures  are  serious  accidents  and  require  prompt 
attention.  The  general  principles  of  treatment  so  far  as  the  bone 
is  concerned  (place  it  in  normal  position  and  keep  it  there)  are  the 
same  as  for  simple  fracture.  But  to  do  this  and  at  the  same  time 
give  proper  attention  to  the  wound  in  the  soft  parts  (the  open  wound 
extending  down  to  the  bone)  frequently  demands  the  highest  surgical 
skill. 

Shock  from  loss  of  blood  is  the  immediate  danger.  Inflammation, 
erysipelas,  blood  poisoning,  or  lockjaw  may  set  in  later,  and  still 
later  the  patient  may  become  exhausted  from  long-continued  suppu- 
ration. 


56  MEDICAL  HANDBOOK. 

Treatment. — If  the  wound  is  very  small,  it  should  be  well  cleaned 
with  hot  water  (water  that  has  been  raised  to  the  boiling  point  and 
allowed  to  cool  down  to  about  120°  F.)  or  by  antiseptic  solution 
(solution  bichloride  of  mercury  1  to  5,000),  then  covered  with  aseptic 
gauze,  and  the  case  treated  as  a  simple  fracture.  (Clean  hands  as 
indicated  on  page  39.) 

In  nearly  all  cases,  however,  the  safest  and  best  plan  is  to  leave 
the  wound  uncovered  by  splint  or  bandage,  so  that  light  dressings 
may  be  easily  applied  and  frequently  changed.  The  wound  should 
be  thoroughly  cleansed  with  hot  water  and  antiseptic  solution,  and, 
after  reducing  the  fracture,  the  splints  or  extending  apparatus  should 
be  so  arranged  that  the  wound  is  freely  accessible  and  easily  drained. 
Strips  of  aseptic  gauze  should  be  placed  in  the  wound  and  gently 
carried  down  to  the  bottom  by  means  of  a  probe,  and  a  larger  piece 
of  aseptic  gauze  in  loose  folds  should  be  laid  over  the  wound. 

The  aseptic-gauze  dressing  should  be  renewed  every  day  or  every 
second  day  or  as  often  as  necessary  to  keep  the  wound  well  drained 
until  it  heals  from  the  bottom. 

In  severe  cases  amputation  may  be  necessary  to  save  life,  and  in 
all  cases  the  patient  should  be  placed  under  the  care  of  a  surgeon  as 
soon  as  possible. 

DISLOCATIONS. 

A  bone  is  dislocated  or  "out  of  joint"  when  it  is  displaced  or 
forcibly  separated  from  another  bone  entering  into  the  composition 
of  a  joint. 

Dislocations  may  be  complete  or  incomplete.  A  dislocation  is 
complete  when  the  articular  surfaces  are  entirely  separated  and  the 
ligaments  torn,  as  in  dislocation  of  the  hip  joint;  incomplete  when 
the  articular  surfaces  are  not  entirely  displaced.  Dislocations  may 
be  simple,  compound,  or  complicated. 

A  dislocation  is  simple  when  there  is  no  wound  of  the  skin  and  soft 
parts — when  the  articular  surfaces  are  not  exposed  to  the  outer  air; 
compound  when  there  is  an  open  wound  and  the  outer  air  is  brought 
into  contact  with  the  articular  surfaces  of  the  joint;  complicated 
when  besides  the  dislocation  there  is  a  fracture  and  serious  damage 
to  the  soft  parts,  or  to  blood  vessels  or  nerves. 

,  -Dislocations  are  said  to  be  most  common  in  adult  or  middle  life, 
when  the  bones  are  strong  and  the  muscles  powerful.  In  the  young 
and  old  the  bones  are  more  apt  to  break.  There  are,  however,  strik- 
ing exceptions  to  this  rule  when  applied  to  the  elbow  joint  and  the 
shoulder  joint.  The  elbow  joint  in  young  subjects  is  frequently  dis- 
located; and  dislocation  of  the  shoulder  joint  in  old  men  is  not 
uncommon. 


INJURIES.  57 

Symptoms  and  signs  of  dislocations. — Deformity  is  always  present 
and  may  be  determined  by  comparing  the  injured  side  with  the 
sound  one.  The  head  or  end  of  the  bone  is  in  an  abnormal  position ; 
the  attitude  of  the  limb  is  changed;  the  patient  can  not  move  the 
limb;  and  when  effort  is  made  to  move  the  joint  it  is  found  to  very 
stiff.  There  may  be  shortening  or  lengthening.  For  example,  in 
dislocation  of  the  hip  the  head  of  the  thigh  bone  may  be  thrown 
outward  and  upward,  when  there  will  be  shortening  of  the  leg;  or  it 
may  be  forced  downward  and  inward,  when  the  length  of  the  limb 
will  be  increased. 

Treatment. — The  indications  are  to  replace  the  bones  in  their 
natural  position  and  to  keep  the  parts  at  rest  until  the  ligaments  and 
damaged  tissues  about  the  joint  are  healed.  A  dislocation  should  be 
reduced  immediately  after  the  accident  whilst  the  patient  is  faint 
and  the  muscles  are  in  a  relaxed  condition. 

Having  thus  briefly  described  a  dislocation  and  the  treatment  indi- 
cated, the  question  now  .arises,  How  shall  the  treatment  be  applied, 
how  shall  the  dislocation  be  reduced  ?  And  when  it  is  taken  into  con- 
sideration that  the  reduction  of  dislocations  not  infrequently  taxes 
the  skill  of  the  most  experienced  surgeon  (even  with  the  aid  of  gen- 
eral anesthetics),  it  is  hardly  to  be  expected  that  a  nonprofessional 
man  will  be  able  to  accomplish  the  desired  results  in  many  cases.  It 
must  also  be  borne  in  mind  that  there  are  certain  dangers  attending 
efforts  at  reduction,  especially  at  the  larger  joints,  if  improperly  or 
too  forcibly  applied — such  as  fraction  of  bone  or  rupture  of  blood 
vessel. 

DISLOCATION  OF  THE  FINGERS. 

Dislocation  of  the  bones  of  the  fingers  may  be  backward  or  forward. 

Treatment. — Extension  and  counter  extension  and  manipulation. 
Pull  the  finger  directly  in  line  with  the  hand,  and  when  fully  ex- 
tended make  pressure  on  the  head  of  the  bone.  Reduction  is  usually 
effected  without  much  difficulty.  Place  the  finger  on  a  well-padded 
splint  for  one  week,  then  make  passive  motion,  and,  if  necessary,  the 
splint  may  be  worn  for  another  week. 

DISLOCATION  OF  THE  THUMB. 

Dislocation  of  the  thumb  may  be  backward  or  forward. 

Treatment. — The  treatment  is  not  the  same  as  for  dislocation  of 
the  fingers,  and  reduction,  especially  of  the  backward  dislocation,  is 
usually  very  difficult.  Try  by  pushing  the  end  of  the  thumb  upward 
and  backward  until  it  stands  perpendicularly  on  the  bone  from  which 
it  is  dislocated,  then  make  strong  pressure  against  the  base  of  the 
dislocated  bone  from  behind  forward,  sliding  it  on  the  bone  beneath 
till  it  gets  to  the  end,  then  flex  or  bend  the  thumb  into  place. 


58  MEDICAL  HANDBOOK. 

DISLOCATION  OF  THE  WRIST. 

Dislocation  of  the  wrist  joint  may  be  backward  or  forward.  It  is 
a  rare  injury.  Fracture  about  the  wrist  is  more  common,  and  is 
sometimes  mistaken  for  dislocation.  A  stiff  joint  is  apt  to  be  the 
result. 

Treatment. — Extension,  counter  extension,  and  direct  pressure. 
Grasp  the  hand  of  the  patient,  pull  in  a  straight  line,  and  have  an 
assistant  pull  on  the  forearm  in  the  opposite  direction,  and  when  the 
parts  are  fully  extended  make  direct  pressure  upon  the  wrist  bones. 
Apply  a  bandage,  and  place  the  hand  and  forearm  on  a  well-padded 
splint  for  a  week ;  then  remove  the  splint  and  make  passive  motion  at 
the  joint;  reapply  the  splint  and  remove  it  after  an  interval  of  an- 
other week.  If  there  is  much  pain  or  swelling  after  reduction  of  the 
dislocation,  apply  cold  water. 

DISLOCATION  OF  THE  ELBOW. 

Dislocations  of  the  elbow  are  serious  accidents.  They  present  a 
variety  of  forms,  backward,  forward,  outward,  and  inward,  and  these 
are  divided  into  a  number  of  subvarieties.  One  or  both  bones  may  be 
involved,  and  the  dislocation  may  be  associated  with  fracture.  Re- 
duction in  some  cases  is  comparatively  easy,  in  others  it  is  very  diffi- 
cult, even  in  the  hands  of  experienced  surgeons. 

Without  a  thorough  knowledge  of  the  anatomy  of  the  normal  joint 
it  is  very  difficult  to  understand  the  different  forms  of  dislocation,  and 
of  necessity  equally  difficult  to  apply  the  proper  treatment. 

Immediately  after  the  accident  and  before  swelling  sets  in  the 
injured  elbow  should  be  carefully  compared  with  the  sound  one. 
When  the  normal  arm  is  extended  (straight)  the  tip  of  the  elbow  and 
the  bony  points  on  either  side  should  be  in  a  transverse  line  across  the 
joint.  If  these  prominences  are  found  out  of  line,  dislocation  or  frac- 
ture is  probably  present. 

Treatment. — Fixation  of  the  arm  above  the  elbow,  extension  or 
flexion  of  the  forearm,  and  direct  pressure  by  means  of  the  thumbs  or 
fingers  on  the  head  of  the  dislocated  bone,  so  as  to  push  it  back  into 
the  socket.  After  reduction  an  angular  splint  should  be  applied  to 
inner  side  of  arm  (fig.  7),  lightly  bandaged,  and  the  forearm  carried 
in  a  sling.  Cold  water  may  be  applied  to  reduce  inflammatory  action. 
Passive  motion  should  be  employed  at  the  end  of  a  week. 

DISLOCATION  OF  THE  SHOULDER. 
[After  Helfrich.] 

Dislocation  of  the  shoulder  joint  is  a  very  common  accident.  It 
occurs  as  frequently  as  all  other  dislocations  put  together.  The  fre- 
quency is  explained  by  the  great  latitude  of  motion  of  the  joint,  the 


INJURIES. 


59 


shallowness  of  the  socket,  and  the  size  and  rounded  shape  of  the  head 
of  the  bone,  the  laxity  of  the  capsular  ligament,  and  the  leverage 
exerted  on  the  joint  by  the  long  bone. 

There  are  three  chief  forms  of  dislocation  of  the  shoulder — (1)  for- 
ward and  downward  below  the  collar  bone,  (2)  directly  downward 
into  the  armpit,  and  (3)  backward  on  the  shoulder  blade. 

The  symptoms  and  signs  are  pain,  swelling,  rigidity  (stiffness), 
loss  of  power,  flattening  and  angular  appearance  of  the  shoulder  as 
compared  with  the  other  shoulder,  abnormal  situation  of  the  head  of 
the  bones,  and  change  in  the  axis  of  the  long  bone.  (Fig.  17.)  In 


FIG.  17. — Dislocation  of  the  right  shoulder. 

the  first  variety,  the  most  common  of  all,  the  head  of  the  bone  may 
be  felt  in  front  of  the  armpit  and  below  the  collar  bone,  and  the  elbow 
points  outward  and  backward.  In  the  second  the  head  of  the  bone 
may  be  felt  in  the  armpit,  and  the  elbow  points  outward.  In  the 
third  the  head  of  the  bone  may  be  felt  on  the  back  of  the  shoulder 
blade,  the  elbow  points  forward,  and  the  forearm  is  thrown  across 
the  chest.  Another  valuable  sign  is  that  when  the  elbow  is  placed  on 
the  chest  the  patient  can  not  place  the  hand  of  the  injured  side  upon 
the  opposite  shoulder,  or  if  the  hand  is  placed  on  the  shoulder  the 
elbow  can  not  be  brought  into  contact  with  the  chest. 


60  MEDICAL  HANDBOOK. 

Treatment. — The  treatment  for  the  first  variety  (forward  and 
downward)  is  as  follows:  Lay  the  patient  down  or  let  him  sit  on  a 
chair;  bend  the  forearm  on  the  arm;  press  the  elbow  against  the 
side  of  the  chest  and  hold  it  there ;  rotate  the  arm  outward  by  carry- 
ing the  forearm  outward ;  pull  steadily  on  the  arm  and  rotate  inward 
by  carrying  the  elbow  upward  and  forward  with  forearm  across  the 
chest.  While  this  is  going  on  have  an  assistant  place  his  hand  in 
the  armpit  and  press  the  head  of  the  bone  into  place. 

For  the  second  variety  (directly  downward  into  the  armpit)  place 
the  patient  on  his  back;  remove  your  boot;  place  your  heel  in  the 
armpit ;  grasp  the  wrist  and  pull  steadily  on  the  arm.  If  the  dislo- 
cation is  in  the  right  shoulder,  seat  yourself  on  the  right  side  of  the 
patient  and  use  your  right  foot;  and  if  the  injury  is  in  the  left 
shoulder  seat  yourself  on  the  left  side  and  use  your  left  foot.  The 
same  principles  may  be  carried  out  by  seating  the  patient  on  a  low 
chair  and  placing  your  knee  in  the  armpit. 

Another  method  is  to  have  an  assistant  stand  upon  a  table  and 
make  counter  extension  with  a  towel,  or  a  strong  piece  of  soft  cloth 
of  any  kind,  passed  under  the  armpit  of  the  patient,  while  the  oper- 
ator pulls  the  arm  downward.  The  same  method  may  be  employed 
by  causing  the  patient  to  lie  on  his  back,  and  an  additional  advantage 
may  be  obtained  by  placing  a  rolled  bandage  or  a  pad  of  any  kind  in 
the  folds  of  a  towel  in  the  armpit. 

In  dislocation  backward  on  the  shoulder  blade,  pull  the  arm  for- 
ward and  make  direct  pressure  forward  on  the  head  of  the  bone,  or 
stand  behind  the  patient,  draw  the  elbow  backward,  and  with  the 
thumb  press  upon  the  head  of  the  bone  and  guide  it  into  place. 

After  reduction  a  soft  pad  should  be  placed  in  the  armpit,  the 
upper  arm  bandaged  to  the  body,  and  the  forearm  placed  in  a  sling 
across  the  chest.  Passive  motion  at  the  joint  should  begin  at  the 
end  of  a  week  and  be  repeated  daily,  but  the  arm  should  be  carried 
in  the  sling  about  three  weeks. 

DISLOCATION  OF  THE  COLLAR  BONE. 

The  collar  bone  extends  from  the  upper  border  of  the  breast  bone 
to  the  highest  point  of  the  shoulder  blade.  Dislocation  may  occur 
at  either  end.  Reduction  is  comparatively  easy,  but  it  is  difficult 
to  retain  the  bone  in  position. 

Treatment. — Make  extension  by  drawing  back  the  shoulders,  the 
knee,  if  necessary,  being  placed  between  the  shoulder  blades;  push 
the  end  of  the  bone  in  place  and  try  to  keep  it  there  by  a  firm  pad 
fastened  by  adhesive  plaster  and  bandage.  The  best  result  may  be 
obtained  by  placing  the  patient  at  rest  on  his  back  for  three  weeks. 


INJURIES.  61 

DISLOCATION  OF  THE  TOES. 

Dislocations  of  the  toes  are  very  rare  accidents.  The  treatment  is 
the  same  as  for  dislocation  of  the  fingers.  Dislocation  of  the  big 
toe  may  be  treated  the  same  as  dislocation  of  the  thumb. 

DISLOCATION  OF  THE  ANKLE. 

The  foot  may  be  dislocated  forward,  backward,  outward,  inward, 
or  upward.  The  dislocation  may  be  complete  or  incomplete. 

The  lower  ends  of  the  bones  of  the  leg  enter  into  the  formation 
of  the  ankle  joint,  the  end  of  the  tibia  on  the  inner  side  and  the  end 
of  the  fibula  on  the  outer  side  of  the  joint.  Dislocations  of  the  ankle 
are  usually  complicated  by  fracture  of  the  tip  of  one  or  both  of  these 
bones.  When,  in  addition,  the  fibula  is  broken  above  the  ankle,  the 
injury  is  known  as  Pott's  fracture,  already  referred  to. 

Treatment. — Extension,  counter  extension,  and  pressure.  Flex 
the  leg  on  the  thigh  and  the  thigh  at  right  angle  to  body;  pull 
steadily  on  the  foot,  while  an  assistant  makes  counter  extension  at 
the  thigh,  and  press  the  bones  in  place.  Apply  cold  water  and  place 
the  foot  and  leg  in  a  fracture  box  or  apply  well-padded  molded 
splints.  Binder's  board  dipped  in  warm  water  and  molded  to  the 
part  and  lined  with  thick  layers  of  cotton  'will  answer  the  purpose. 
If  a  Pott's  fracture,  use  the  splint  shown  in  figure  15.  Make  passive 
motion  at  the  joint  at  the  end  of  two  weeks. 

DISLOCATION  OF  THE  KNEE. 

Dislocation  of  the  knee  may  be  complete,  incomplete,  compound, 
or  complicated.  The  direction  of  the  dislocation  may  be  forward, 
backward,  outward,  or  inward.  The  deformity  is  quite  marked. 
Reduction  is  not  very  difficult,  but  the  injury  is  a  serious  one  and 
care  must  be  taken  in  making  reduction  not  to  produce  additional 
damage  by  too  forcible  extension.  Fortunately  the  injury  is  exceed- 
ingly rare. 

Treatment. — Extension,  counterextension,  and  pressure.  Have 
one  assistant  pull  steadily,  not  too  hard,  on  the  leg  or  ankle,  while 
another  fixes  or  pulls  on  the  thigh  and  presses  the  bone  into  place. 
After  reduction  apply  cold  water,  and  place  the  leg  in  a  posterior 
straight  splint,  well  padded,  especially  below  the  hollow  of  the  knee, 
and  make  passive  motion  at  the  end  of  two  weeks.  When  the  patient 
begins  to  walk,  a  kneecap  or  flannel  bandage  should  be  applied. 

DISLOCATION  OF  THE  HIP. 

Dislocation  of  the  hip  joint  is  a  serious  injury.  It  occurs  much  less 
frequently  than  dislocation  of  the  shoulder  joint.  The  socket  of  the 
hip  joint  is  very  deep,  and  the  ligaments  and  muscles  surrounding  the 


62 


MEDICAL  HANDBOOK. 


joint  are  very  strong  and  powerful.  Dislocation  occurs  only  when 
the  limb  is  in  a  certain  position,  when  its  axis  is  changed  from  that 
of  the  body,  and  when  in  consequence  of  any  sudden  or  great  force 
received  on  the  lower  end  of  the  leg  or  knee  the  head  of  the  bone  is 
forced  through  the  ligament  (the  capsule)  which  surrounds  the  joints. 
The  head  of  the  bone  may  then  be  thrown  (1)  backward  and  upward, 
(2)  backward,  (3)  forward  and  downward,  (4)  forward.  The  dif- 
ferent directions  indicate  the  different  forms  of  dislocation.  The 
first  is  the  most  common. 

In  the  first  form  examination  from  below  up  shows  the  big  toe 
turned  toward  or  resting  on  the  instep  of  the  opposite  foot ;  the  knee 
flexed  and  resting  against  thigh  at  upper  margin  of  opposite  knee- 


FIG.  18.  FIG.  19. 

Fig.  18  shows  a  backward  dislocation  of  the  hip  with  the  knee  and  toe  turned  In  and 
the  heel  raised  and  the  limb  shortened.  Fig.  19  shows  a  forward  and  downward  dis- 
location of  the  right  hip  with  the  knee  and  toe  turned  out  and  the  limb  lengthened. 

cap ;  the  thigh  rotated  inward  and  drawn  toward  its  fellow ;  bulging 
of  the  hip;. and  about  2  inches  shortening  of  the  entire  limb. 

In  the  second  form  the  signs  are  the  same  as  in  the  first,  but  less 
marked.  (Fig.  18.)  Fracture  of  the  neck  of  the  thigh  bone  is 
sometimes  mistaken  for  this  injury.  But  in  fracture  there  is  abnor- 
mal motion,  and  the  foot  is  turned  outward. 

In  the  third  form  (fig.  19)  the  signs  are  almost  exactly  the  reverse 
of  the  first  form.  The  foot  and  knee  are  turned  -outward,  the  hip  is 
flattened,  and  the  entire  limb  is  lengthened. 

The  signs  of  the  fourth  form  are  nearly  the  same  as  those  of  the 
third,  except  that  the  entire  limb  is  shortened. 

Treatment. — The  treatment  is  by  manipulation,  or  by  extension 
and  counterextension. 


INJURIES.  63 

For  the  first  and  second  forms  of  dislocation,  above-described  treat- 
ment may  be  applied  as  follows :  Place  the  patient  on  his  back  on  a 
mattress  on  the  floor.  Seize  the  foot  or  ankle  with  one  hand  and 
place  the  other  hand  under  the  knee.  Flex  the  leg  upon  the  back  of 
the  thigh,  and  the  thigh  upon  the  body  to  about  a  right  angle ;  then 
carry  the  knee  inward  and  rotate  it  inward  on  its  own  axis,  then  sud- 
denly raise  it  (lift  it  toward  the  ceiling)  so  that  the  head  of  the  bone 
may  be  thrown  over  the  rim  of  the  socket,  and  immediately  extend 
the  limb  with  outward  rotation  to  its  normal  position  so  that  the  head 
of  the  bone  may  return  to  the  socket  through  the  hole  in  the  capsule 
by  which  it  escaped. 

The  treatment  of  the  third  and  fourth  forms  of  injury  corresponds 
to  that  for  the  first  and  second,  except  that  the  limb  should  be  carried 
outward  first,  then  inward,  across  the  median  line,  and  rotated 
inward  on  its  own  axis,  and  then  suddenly  lifted  and  brought  down 
to  its  normal  position  by  the  side  of  its  fellow. 

No  great  force  should  be  used  in  making  these  movements.  If  any 
considerable  resistance  is  met  with  in  rotating  or  lifting  the  bone  the 
movement  should  be  modified  in  such  a  way  that  the  head  of  the  bone 
may  follow  the  path  of  least  resistance. 

If  extension  and  counterextension  be  applied  they  should  follow 
the  line  of  the  axis  of  the  dislocated  thigh.'  It  must  not  be  forgotten 
in  the  consideration  of  these  methods  that  the  application  of  too 
much  force  or  of  force  improperly  applied  may  produce  fracture  of 
the  bone. 

SPRAINS. 

A  sprain  is  a  stretching  or  wrenching  of  a  joint.  The  joints  most 
frequently  affected  are  the  ankle,  wrist,  knee,  and  shoulder. 

The  symptoms  and  signs  are  pain,  swelling,  impairment  or  loss  of 
motion,  and  discoloration  from  effusion  of  blood.  "When  there  is 
much  swelling  it  may  be  difficult  to  determine  whether  sprain  or 
fracture,  or  both,  are  present. 

Treatment. — If  seen  at  once,  before  there  is  much  swelling,  a 
bandage  should  be  applied  from  the  toes  to  2  or  3  inches  above  the 
ankle,  and  the  joint  should  be  kept  at  perfect  rest  in  an  elevated 
position.  If  much  swelling  has  already  taken  place,  apply  cold  ap- 
plications continuously  for  several  hours.  If  the  symptoms  do  not 
rapidly  subside,  apply  hot  applications — cloths  or  towels  wrung  out 
of  hot  water  and  frequently  changed.  After  the  swelling  has  gone 
down  a  bandage  properly  applied  will  afford  considerable  benefit. 
(Fig.  20.) 

The  joint  must  not  be  kept  too  long  at  rest.  Passive  motion  should 
be  performed  as  soon  as  the  inflammatory  symptoms  have  subsided. 


64 


MEDICAL  HANDBOOK. 


NOSEBLEED. 


If  bleeding  of  the  nose  occur  in  a  full-blooded  person,  especially 
if  such  person  is  subject  to  dizziness,  we  should  not  be  in  too  much  of 
a  hurry  to  stop  it.  But  if  the  bleeding  is  the  result  of  injury  or  if  it 
occur  in  a  person  suffering  from  disease  of  the  heart  or  lungs  or  from 
the  effects  of  malarial  fever,  scurvy,  or  any  disease  of  the  general 
system,  effort  should  be  made  to  stop  it. 

Treatment. — Remove  all  pressure  of  clothing  from  neck  and  chest. 
Caution  patient  not  to  blow  his  nose.  If  too  weak  to  stand,  place 
him  on  his  back  with  his  arms  raised  and  his  head  on  a  high  pillow. 
Bathe  the  nose  in  cold  water,  apply  cold  water  to  back  of  neck  or  an 
ice  bag  to  the  forehead.  Pack  the  nostrils  with  pellets  of  absorbent 
cotton.  The  bleeding  is  sometimes  brought  under  control  by  the 
application  of  hot  water  to  the  nostrils. 


FIG.  20. — Shows  the  application  of  adhesive  plaster  to  an  ulcer  of  the  leg  at  A  and  of  an 
ordinary  bandage  from  the  foot  up  the  leg,  B. 

In  very  severe  cases  the  posterior  as  well  as  the  anterior  nares 
should  be  plugged.  In  the  absence  of  a  physician  the  application  of 
this  method  may  be  attended  with  some  difficulties.  But  if  the 
master  or  keeper  decides  to  try  it  he  may  proceed  as  follows :  Pass  a 
fine  string  twine,  about  20  inches  long,  through  the  eye  of  a  hard 
rubber  catheter,  and  thus  armed  pass  the  catheter  along  the  floor  of 
the  nose  to  the  back  of  the  mouth  below  the  soft  palate ;  introduce  a 
forceps  into  the  mouth  back  to  the  end  of  the  catheter^  seize  the 
twine,  and  bring  it  out  of  the  mouth.  Then  tie  a  wad  of  absorbent 
cotton  or  lint  to  the  twine  about  12  inches  from  the  end  of  it ;  then 
pull  on  the  catheter  and  the  other  end  of  the  twine  and  draw  the  wad 
into  the  mouth,  guided  by  the  finger,  behind  the  soft  palate  into  the 
posterior  nares.  He  will  thefn  have  the  posterior  nares  plugged,  and 
one  end  of  the  twine  hanging  out  at  the  mouth  and  the  other  end  at 
the  nose. 


RESTORATION    OF   APPARENTLY   DROWNED. 


65 


Secure  the  ends  of  the  twine  by  tying  them  together,  and  allow 
the  plug  to  remain  about  two  days. 

The  wad  of  cotton  or  lint  should  be  about  an  inch  long  and  half  an 
inch  wide. 

DIRECTIONS  FOR  RESTORING  THE  APPARENTLY  DROWNED. 

[As  practiced  in  the  United  States  Life-Saving  Service.] 

Rule  I. — Arouse  the  patient. — Do  not  move  the  patient  unless  in 
danger  of  freezing;  instantly  expose  the  face  to  the  air,  toward  the 
wind  if  there  be  any ;  wipe  dry  the  mouth  and  nostrils ;  rip  the  cloth- 
ing so  as  to  expose  the  chest  and  waist;  give  two  or  three  quick, 
smarting  slaps  on  the  chest  with  the  open  hand. 


FIG.  21. 

If  the  patient  does  not  revive,  proceed  immediately  as  follows : 
Rule  II. — To  expel  water  from  the  stomach  and  chest  (see  fig, 
21). — Separate  the  jaws  and  keep  them  apart  by  placing  between  the 
teeth  a  cork  or  small  bit  of  wood ;  turn  the  patient  on  his  face,  a  large 
bundle  of  tightly  rolled  clothing  being  placed  beneath  the  stomach; 
press  heavily  on  the  back  over  it  for  half  a  minute,  or  as  long  as  fluids 
flow  freely  from  the  mouth. 

Rule  III. — To  produce  breathing  (see  figs.  22  and  23). — Clear  the 
mouth  and  throat  of  mucus  by  introducing  into  the  throat  the  corner 
of  a  handkerchief  wrapped  closely  around  the  forefinger;  turn  the 
patient  on  the  back,  the  roll  of  clothing  being  so  placed  as  to  raise  the 
pit  of  the  stomach  above  the  level  of  the  rest  of  the  body.  Let  an 
assistant  with  a  handkerchief  or  piece  of  dry  cloth  draw  the  tip  of  the 
tongue  out  of  one  corner  of  the  mouth  (which  prevents  the  tongue 

21824°— 12 5 


66 


MEDICAL  HANDBOOK. 


from  falling  back  and  choking  the  entrance  to  the  windpipe),  and 
keep  it  projecting  a  little  beyond  the  lips.  Let  another  assistant 
grasp  the  arms  just  below  the  elbows  and  draw  them  steadily  upward 
by  the  sides  of  the  patient's  head  to  the  ground,  the  hands  nearly 
meeting  (which  enlarges  the  capacity  of  the  chest  and  induces  inspi- 
ration). (Fig.  22.)  While  this  is  being  done  let  a  third  assistant 
take  position  astride  the  patient's  hips  with  his  elbows  resting  upon 
his  own  knees,  his  hands  extended  ready  for  action.  Next,  let  the 
assistant  standing  at  the  head  turn  down  the  patient's  arms  to  the 
sides  of  the  body,  the  assistant  holding  the  tongue  changing  hands  if 
necessary1  to  let  the  arms  pass.  Just  before  the  patient's  hands 


FIG.  22. 

reach  the  ground  the  man  astride  the  body  will  grasp  the  body  with 
his  hands,  the  balls  of  the  thumb  resting  on  either  side  of  the  pit  of 
the  stomach,  the  fingers  falling  into  the  grooves  between  the  short 
ribs.  Now,  using  his  knees  as  a  pivot,  he  will  at  the  moment  the 
patient's  hands  touch  the  ground  throw  (not  too  suddenly)  all  his 
weight  forward  on  his  hands,  and  at  the  same  time  squeeze  the  waist 
between  them,  as  if  he  wished  to  force  anything  in  the  chest  upward 
out  of  the  mouth ;  he  will  deepen  the  pressure  while  he  slowly  counts, 
one,  two,  three,  four  (about  five  seconds),  then  suddenly  let  go  with  a 
final  push,  which  will  spring  him  back  to  his  first  position.2  This 
completes  expiration.  (Fig.  23.) 

At  the  instant  of  his  letting  go,  the  man  at  the  patient's  head  will 
again  draw  the  arms  steadily  upward  to  the  sides  of  the  patient's 

1  Changing  hands  will  be  found  unnecessary  after  some  practice ;  the  tongue,  however, 
must  not  be  released. 
•A  child  or  very  delicate  patient  must,  of  course,  be  more  gently  handled. 


RESTORATION    OF    APPARENTLY   DROWNED. 


67 


head  as  before  (the  assistant  holding  the  tongue  again  changing  hands 
to  let  the  arms  pass  if  necessary) .  holding  them  there  while  he  slowly 
counts  one,  two,  three,  four  (about  five  seconds). 

Repeat  these  movements  deliberately  and  perseveringly  twelve  to 
fifteen  times  in  every  minute — thus  imitating  the  natural  motions  of 
breathing. 

If  natural  breathing  be  not  restored  after  a  trial  of  the  bellows 
movement  for  the  space  of  about  four  minutes,  then  turn  the  patient 
a  second  time  on  the  stomach,  as  directed  in  Rule  II,  rolling  the  body 
in  the  opposite  direction  from  that  in  which  it  was  first  turned,  for 
the  purpose  of  freeing  the  air  passage  from  any  remaining  water. 
Continue  the  artificial  respiration  from  one  to  four  hours,  or  until  the 
patient  breathes,  according  to  Rule  III;  and  for  a  while,  after  the 


FIG.  23. 


appearance  of  returning  life,  carefully  aid  the  first  short  gasps  until 
deepened  into  full  breaths.  Continue  the  drying  and  rubbing,  which 
should  have  been  unceasingly  practiced  from  the  beginning  by  assist- 
ants, taking  care  not  to  interfere  with  the  means  employed  to  produce 
breathing.  Thus  the  limbs  of  the  patient  should  be  rubbed,  always 
in  an  upward  direction  toward  the  body,  with  firm-grasping  pressure 
and  energy,  using  the  bare  hands,  dry  flannels,  or  handkerchiefs,  and 
continuing  the  friction  under  the  blankets  or  over  the  dry  clothing. 
The  warmth  of  the  body  can  also  be  promoted  by  the  application  of 
hot  flannels  to  the  stomach  and  armpits,  bottles  or  bladders  of  hot 
water,  heated  bricks,  etc.,  to  the  limbs  and  soles  of  the  feet. 

Rule  IV. — After  treatment. — Externally:  As  soon  as  breathing  is 
established  let  the  patient  be  stripped  of  all  wet  clothing,  wrapped 


68 


MEDICAL,  HANDBOOK. 


in  blankets  only,  put  to  bed  comfortably  warm,  but  with  a  free 
circulation  of  fresh  air,  and  left  to  perfect  rest.  Internally:  Give 
aromatic  spirits  of  ammonia  in  water  in  doses  of  a  teaspoonful,  or 
other  stimulant  at  hand.  Later  manifestations:  After  reaction  is 
fully  established  there  is  great  danger  of  congestion  of  the  lungs, 
and  if  perfect  rest  is  not  maintained  for  at  least  forty-eight  hours,  it 
sometimes  occurs  that  the  patient  is  seized  with  great  difficulty  of 
breathing,  and  death  is  liable  to  follow  unless  immediate  relief  is 
afforded.  In  such  cases  apply  a  large  mustard  plaster  over  the  breast, 
If  the  patient  gasps  for  breath  before  the  mustard  takes  effect,  assist 
the  breathing  by  carefully  repeating  the  artificial  respiration. 

Modification  of  Rule  III  (to  be  used  after  Rules  I  and  II  in  case 
no  assistance  is  at  hand). — To  produce  respiration. — If  no  assist- 


FIG.  24. 

ance  is  at  hand  and  one  person  must  work  alone,  place  the  patient 
on  his  back  with  the  shoulders  slightly  raised  on  a  folded  article  of 
clothing;  draw  forward  the  tongue  and  keep  it  projecting  just  beyond 
the  lips.  If  the  lower  jaw  be  lifted,  the  teeth  may  be  made  to  hold 
the  tongue  in  place;  it  may  be  necessary  to  retain  the  tongue  by 
passing  a  handkerchief  under  the  chin  and  tying  it  over  the  head. 

Grasp  the  arms  just  below  the  elbows  and  draw  them  steadily 
upward  by  the  sides  of  the  patient's  head  to  the  ground,  the  hands 
nearly  meeting.  (Fig.  24.) 

Next  lower  the  arms  to  the  sides  and  press  firmly  downward  and 
inward  on  the  sides  and  front  of  the  chest  over  the  lower  ribs, 
drawing  toward  the  patient's  head.  (See  fig.  25.) 

Kepeat  these  movements  twelve  to  fifteen  times  every  minute,  etc. 


SAVING  PERSONS   FROM   DROWNING. 


69 


INSTRUCTIONS  FOR  SAVING  DROWNING  PERSONS  BY  SWIM- 
MING TO  THEIR  RELIEF. 

1.  When  you  approach  a  person  drowning  in  the  water,  assure 
him,  with  a  loud  and  firm  voice,  that  he  is  safe. 

2.  Before  jumping  in  to  save  him,  divest  yourself  as  far  and  as 
quickly  as  possible  of  all  clothes ;  tear  them  off,  if  necessary ;  but  if 
there  is  not  time,  loose  at  all  events  the  foot  of  your  drawers,  if  they 
are  tied,  as,  if  you  do  not  do  so,  they  fill  with  water  and  drag  you. 

3.  On  swimming  to  a  person  in  the  sea,  if  he  be  struggling  do  not 
seize  him  then,  but  keep  off  for  a  few  seconds  till  he  gets  quiet,  for  it 
is  sheer  madness  to  take  hold  of  a  man  when  he  is  struggling  in  the 
water ;  and  if  you  do,  you  run  a  great  risk. 

4.  Then  get  close  to  him  and  take  fast  hold  of  the  hair  of  his  head, 
turn  him  as  quickly  as  possible  onto  his  back,  give  him  a  sudden 


FIG.   25. 

pull,  and  this  will  cause  him  to  float,  then  throw  yourself  on  your 
back  also  and  swim  for  the  shore,  having  hold  of  his  hair,  you  on 
your  back  and  he  also  on  his,  and,  of  course,  his  back  to  your 
stomach.  In  this  way  you  will  get  sooner  and  safer  ashore  than  by 
any  other  means,  and  you  can  easily  thus  swim  with  two  or  three 
persons;  the  writer  has  even,  as  an  experiment,  done  it  with  four, 
and  gone  with  them  40  or  50  yards  in  the  sea.  One  great  advantage 
of  this  method  is  that  it  enables  you  to  keep  your  head  up  and  also 
to  hold  the  person's  head  up  you  are  trying  to  save.  It  is  of  primary 
importance  that  you  take  fast  hold  of  the  hair  and  throw  both  the 
person  and  yourself  on  your  backs.  After  many  experiments,  it  is 
usually  found  preferable  to  all  other  methods.  You  can  in  this  man- 


70 


]VfEl5lCAI,   HANDBOOK. 


ner  float  nearly  as  long  as  you  please,  or  until  a  boat  or  other  help  can 
be  obtained. 

5.  It  is  believed  there  is  no  such  thing  as  a  death  grasp ;  at  least 
it  is  very  unusual  to  witness  it.     As  soon  as  a  drowning  man  begins 
to  get  feeble  and  to  lose  his  recollection,  he  gradually  slackens  his 
hold  until  he  quits  it  altogether.     No  apprehension  need,  therefore, 
be  felt  on  that  head  when  attempting  to  rescue  a  drowning  person. 

6.  After  a  person  has  sunk  to  the  bottom,  if  the  water  be  smooth, 
the  exact  position  where  the  body  lies  may  be  known  by  the  air  bub- 
bles, which  will  occasionally  rise  to  the  surface,  allowance  being,  of 
course,  made  for  the  motion  of  the  water,  if  in  a  tide  way  or  stream 
which  will  have  carried  the  bubbles  out  of  a  perpendicular  course  in 
rising  to  the  surface.     Oftentimes  a  body  may  be  regained  from  the 
bottom  before  too  late  for  recovery  by  diving  for  it  in  the  direction 
indicated  by  these  bubbles. 

7.  On  rescuing  a  person  by  diving  to  the  bottom  the  hair  of  the 
head  should  be  seized  by  one  hand  only  and  the  other  used  in  con- 
junction with  the  feet  in  raising  yourself  and  the  drowning  person 
to  the  surface. 

8.  If  in  the  sea,  it  may  sometimes  be  a  great  error  to  try  to  get  to 
land.     If  there  be  a  strong  "  outsetting  "  tide,  and  you  are  swimming 
either  by  yourself  or  having  hold  of  a  person  who  can  not  swim,  then 
get  on  your  back  and  float  till  help  comes.     Many  a  man  exhausts 
himself  by  stemming  the  billows  for  the  shore  on  a  back-going  tide 
and  sinks  in  the  effort,  when  if  he  had  floated  a  boat  or  other  aid 
might  have  been  obtained. 

9.  These  instructions  apply  alike  to  all  circumstances,  whether  as 
regards  the  roughest  sea  or  smooth  water. 


INDEX. 


Page. 

Page. 

Ankle: 

Dislocation  

61 

Kneecap,  fracture  

52 

Sprain  

63 

Leg: 

Antidotes  for  poisons  
Appendicitis  
Arm,  fracture  

9 
31 
46,47 

Fracture  , 
Ulcer,  bandage  for  treatment  (fig.  20).  .. 
Laudanum,  antidote  for  

49,53 
64 
9 

Arsenic,  antidote  for  

9 

Malarial  fever  

10 

Articles  for  medicine  chest  

6 

Measles  

12 

Back  ,  inj  uries  

43 

Medicines,  list  

6 

Bichloride  of  mercury,  antidote  for  — 

9 

Morphine,  antidote  for  

9 

Bleeding  

37 

Mosquitoes  

8 

Boils  

37 

Mouth,  care  of  

9 

Bones,  broken  

43 

Mumps  

14 

Bronchitis  

25 

Nosebleed  

64 

Burns  

40 

Opium,  antidote  for  

9 

Carron  oil,  formula  

41 

Paregoric,  antidote  for  

9 

Carbolic  acid  ,  antidote  for  

9 

Paris  green,  antidote  for  

9 

Chancre  (chancroid)  

32 

Personal  cleanliness  

8 

Chest,  injuries  

42 

Poison  ivy  

27 

Cholera  morbus  

21 

Poisons  

9 

Clap  (gonorrhea)  

.......        34 

Pott's  fracture  

54 

Cleanliness  of  person  

8 

P  iles  

37 

Cold,  effects  of  

41 

Quinsy  

24 

Colds  

25 

Rheumatism  

27 

Colic  

22 

Rib,  fracture  

42 

Collar  bone,  dislocation  

60 

St.  Anthony's  fire  (erysipelas)  

26 

Corrosive  sublimate,  antidote  for  

9 

Sanitation  

7 

Coughs  

25 

Scalds  

40 

Delirum  tremens  

30 

Scalp,  wounds  

42 

Diarrhea  

20 

Scurvy  

23 

Diet  

8 

Shoulder: 

Disinfecting  solutions  

7 

Dislocation  

58 

Dislocations  

56 

Sprain  

63 

Drowning  presons: 

Smallpox  

15 

Resuscitation  of  

65 

Sore  throat  

24 

Swimming  to  relief  of  

69 

Spine,  sprain  of  

43 

Drugs,  list  

6 

Sprains: 

Dysentery  

18 

General  

63 

Elbow  ,  dislocation  

58 

Of  the  back  

43 

Erysipelas  

26 

Stricture  of  urethra  

35 

Fainting  

30 

Sunstroke  

19 

Fever: 

Syphilis  

31 

Malarial  

10 

Syphilitic  rheumatism  

30 

Rheumatic  

27 

Teeth: 

Fingers: 

Care  of  

9 

Dislocation  

57 

Toothache  

9 

.    Fracture  

46 

Thermometer  

9 

Flies  

7 

Thigh,  fracture  

49 

Forearm,  fracture  

46 

Toothache  

9 

Fractures  

43 

Thumb: 

Frostbite  

41 

D  islocation  

57 

Gonorrhea  

34 

Fracture  

46 

Gonorrheal  rheumatism'.  

29 

Toes,  dislocation  

61 

Hemorrhage  

37 

Tonsillitis  

24 

Hip,  dislocation  

61 

Ulcer,  bandage  for  treatment  of  (fig.  20)  

64 

Injuries  

37 

Urethra,  stricture  of  

35 

Jaw,  fracture  

44 

Wounds  

38 

Knee: 

Wrist: 

Dislocation  

61 

Dislocation  

58 

Sprain  

63 

Sprain  

63 

71 

o 


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LD  21-100m-8,'34 


23658G 


